By Mayur Yermaneni, EVP, Strategy and Innovation, AssureCare
Value-based care is one of the most important topics in healthcare transformation today and will be a prominent player in the healthcare landscape throughout 2023. The shift from fee-for-service models to performance-based reimbursement will continue to demonstrate better care for lower costs through incremental improvement and positive outcomes. While COVID-19 stymied adoption of at-risk models and progress toward VBC, the timing is now perfect for rapid and valuable advancements.
However, new technological capabilities are required to build more economically stable, value-based care agreements. A stronger emphasis on interoperability between providers and payers is essential to ensure VBC works for all sides of the healthcare ecosystem.
In my recent interview on FINN Voices on Healthcare NOW Radio, I share specific technology advancements required for faster and more effective adoption of VBC in 2023. Here is a summary of those predictions.
Become More Proactive with Population Health Platforms: 1+1=3
As the equation denotes, more proactive collaboration among payers, providers, the government and patients can help achieve great things. Provider-sponsored population health initiatives must become timely and inclusive to support advanced value-based care models. The use of real-time data to inform risk-based contract negotiations with payers is also essential.
Likewise, payers want providers to be successful in VBC, which requires greater collaboration through technology. However, for payers and providers, technology gaps remain. Core technology is needed to deliver the “warranty” people are looking for in a strong VBC program.
Here is a brief technology checklist for the year ahead.
- Ensure your population health platform proactively identifies patient care gaps—in real time (not retrospectively) based on claims data to deliver more precise and timely results.
- Share important changes in patient status with providers quickly through efficient (not disruptive) clinical workflows to reduce preventable encounters and costs.
- Automate manual processes in care coordination and communication among providers, care managers, payers and community programs to reduce administrative burden.
- Leverage centralized analytics that integrate patient and member activity across multiple stakeholders. Disseminate findings rapidly to strengthen physician alignment and improve medical-cost-management performance by providers.
Some of the largest value-based care performance reviews have found that proactive actions correspond to improved outcomes, increased preventative care, and greater patient and member satisfaction.
Embrace Inclusivity to Expand Care Coordination
Inclusivity is another valuable strategy to consider for VBC success. This means inclusion of ancillary clinical services and employers. For example, pharmacy services are perhaps the most disregarded, but most valuable, clinical partnerships to embrace.
Expansion to integrate pharmacy practices into population health cannot be an afterthought or remain segmented, like behavioral health was for many years and remains now to some extent. Also, pharmacists present a major opportunity to address workforce challenges, support care teams and extend the reach of care coordination across the community.
Best practice is to enable pharmacists’ provider status within your EHR and customize population health components to connect the patient, pharmacies and payers. By connecting pharmacy services, organizations take full advantage of new pharmacist-based care delivery opportunities.
Employers are another important stakeholder to include in 2023 VBC plans. Employers have the middle seat in payer and provider interactions. In the past, these employer decisions were made by human resource administrators. Today, we see more engagement by employer CEOs in the handling and management of this information.
Deliver on the Warranty of VBC
As mentioned above, every healthcare stakeholder is looking for the long-promised warranty of value-based care, including the patient. The core technology needed to achieve this goal is a strong population health and care management platform—with more advanced, timely and inclusive capabilities.
Technological innovations will certainly play an important role in delivering more proven, scalable and repeatable VBC successes in the year ahead.
Listen to the Episode!