How can healthcare achieve value-based care?

June 3, 2016 conduentblogs

By Mary-Margaret Franclemont

By Mary-Margaret Franclemont
Mary-Margaret Franclemont, director of Marketing and Communications, Healthcare Payer Services

When you receive healthcare today, your provider likely charges you for each office visit, procedure and test performed – whether you receive the itemized bill or your insurance company does. This is known as the fee-for-service payment method in the healthcare industry – and it is soon to be a thing of the past. The industry is transitioning to value-based care, meaning providers are compensated for healthy outcomes rather than for each service provided. And by 2018, the Centers for Medicare and Medicaid Services (CMS) will require 50 percent of all healthcare contracts to be value-based.

Yet, recent surveys indicate that a majority of healthcare payers and providers still operate predominantly in a fee-for-service environment, leaving much ground to make up.

Xerox Survey: 43% of healthcare providers and payers say value-based contracts make up less than 10 percent of their current portfolio.

Population health management has been widely discussed as the solution to help healthcare organizations reach their value-based care goals – but definitions of what this path looks like vary and many don’t know where to start.

Xerox survey:Payers and providers indicate that they need a lot of additional support to manage value-based care contracts in areas including: 34% analytics, 35% technology and 32% people based.

Earlier this month, I had the pleasure of attending a panel discussion on this topic at the Health Data Management Most Powerful Women in Health IT conference in Boston.

Here are three key takeaways from the discussion with four leading healthcare executives: Mandi Bishop, Tamara StClaire, Dr. Terri Steinberg and Dr. Katherine Schneider.

There are barriers on the path to value-based care, but Population Health Management – no matter how it’s defined – can help.

Industry stakeholders seem to agree that achieving value-based care will involve a few critical components: Real-time data and predictive analytics.

Real-time data enables predictive analytics and clinical decision support which can help payers and providers address at-risk populations, provide better care and timelier interventions.

Analytics can help us determine if there are gaps in care and whether healthy outcomes were achieved – which can inform whether or not value-based payments are deserved. These are key to any population health management approach.

Look for technology and service partners that support people, processes AND workflow.

We often think of healthcare transformation in terms of technology implementation. But people and processes are at least half the equation. If technology that promises to deliver benefits is implemented but sitting unused, or used incorrectly, we can’t expect meaningful results. Providers and payers need to work with partners who can help them prioritize adoption, education and training so the technology is used consistently and accurately to achieve the desired outcomes.

Patients are – and should be – our most valued partners in healthcare.

Patients are the most critical asset to improving the bottom line, but oftentimes payers and providers are talking about the patient and around the patient – but the patient doesn’t have a seat at the table.

Patients need to be partners in healthcare. They can help ascertain the right care needed and whether they believe a healthy outcome was achieved.

Moreover, studies show that patients want to be more active and involved in their own healthcare. Payers and providers need to take advantage of this opportunity to engage with patients about their health to achieve mutual health goals and coordinate better care across the continuum.

Xerox survey: 91% of all consumers want to be more proactive in their healthcare.

Although it’s clear that the transition hasn’t occurred, the industry is optimistic about achieving value-based care goals. Moreover, many industry leaders believe that Population Health Management can help them get there.

However, payers and providers will need to define what success looks like for their organizations first and then partner with ALL of the key stakeholders – but most importantly, with the patient – to help make value-based care goals and population health management a reality.

About the Author


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