The Future of Value-Based Care


Survey results indicate a need for operational expertise.


Healthcare executives see several barriers to value-based care success. At the top of the list is a lack of resources, including a shortage of staff and insufficient technology. Execs are also concerned that interoperability issues will make it difficult to coordinate care and efficiently exchange patient data, according to a recent survey.

The survey by Definitive Healthcare, polled 1,090 healthcare leaders across the provider, biotech, financial services, staffing, life sciences, IT, and consulting verticals to determine predictions for the future of the value-based care landscape.

“While healthcare leaders recognize the need for solutions that advance value-based care initiatives and support quality-of-care objectives, they often lack the operational expertise to implement initiatives that drive physician and consumer engagement, facilitate risk management, and empower financial success,” says Michael Cousins, chief analytics officer for Lumeris, an industry leader in value-based care, located in St. Louis.

“As the industry continues to shift from fee-for-service to value-based reimbursement models, healthcare systems realize that the implementation of new technologies are essential for clinical and financial success,” Cousins says. “Leaders realize the need for solutions that advance population health initiatives and support quality care objectives. At the same time, many organizations recognize they may lack the operational expertise to implement solutions that drive physician and consumer engagement, facilitate risk management, and empower financial success.”

The introduction of value-based payment models has effectively forced payers and providers to adopt innovative behaviors in order to achieve their revenue goals, according to Cousins.

“By aligning payments to the concepts of improved quality and outcomes for consumers, both payers and providers share financial goals and must now focus on the delivery of appropriate and cost-effective care that leads to improved outcomes and satisfied patients. Payers and providers must collaborate and cooperate with one another to drive financial and clinical success,” he says.

However, changing long-established routines and behaviors takes hard work and requires time, according to Cousins.

Related: Best Practices in Value-Based Care

“Although they’ve made progress in recent years, payers and providers have been slow to collaborate, both fearing that a closer alliance could in some way jeopardize their success, based on their historic adversarial relationship,” he says.

Based on the study, Cousins has two pieces of advice for healthcare executives:

  • Don’t be paralyzed by inaction. “Many healthcare executives feel uncertainty about key questions related to value-based care, such as how fast the transformation should occur and what barriers are likely to arise during the journey. Some are focusing on more traditional strategies that will not achieve substantive results, while others are attempting to navigate the transition alone, learning as they go,” he says.

  • Develop an effective risk management strategy. “Often, an operational and financial partner can help healthcare organizations make the transition and more quickly get a return on its investment in value-based care,” Cousins says. “Effective risk management is a key element to ensuing a return on investment.”

Through historical data analysis and predictive modeling, Cousins identified the following six drivers of successful performance in value-based care: 

1. Aligned incentive contracting

2. Effective physician compensation and incentives

3. Physician mindshare

4. Ideal leadership and organizational structure

5. Powerful technology and information

6. Practice transformation and accountable primary care delivery

“Each of the six key drivers requires an immense amount of complicated work, often outside of healthcare organizations’ areas of expertise,” he says. “Decisions about where to start, when and how to implement each component, and how the pieces fit together can be overwhelming. Healthcare organizations that want to avoid the steep learning curve may find the straightest path to success by working with an operating partner that has a track record of moving organizations to value using proven methodologies that drive enhanced consumer and physician satisfaction.”

Cousins advises that healthcare executives should consider a partner with over a decade of experience in managing risk contracts and operating health plan; expertise in advanced analytics and value-based care technology; and a collaborative payer model that enables physicians to deliver improved clinical and financial outcomes. 


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