Rising care costs and a lack of connection between health spending and health outcomes have seen value-based care models emerge as healthcare’s great new frontier.
The journey toward this transformative future has seen notable progress. In a recent study, a compelling 80 percent of physicians expressed interest in participating in value-based care arrangements.1 Regulatory developments are also fueling this change. In the US, the Centers for Medicare & Medicaid Services or CMS aims for 100 percent of Medicare beneficiaries to be in accountable care relationships by 2030, setting the scene for a decade of innovation.2
Significant financial backing is aligning with this vision. Investment in value-based care in the US soared to USD 10.7 Billion in the 12 months ending March 2023 – a remarkable 39 percent increase from the previous year’s USD 7.7 Billion.3
Despite this surge in interest, providers face many hurdles when adopting value-based care models. In a system still geared more toward fee-for-service, many do not feel equipped to take on risk-based payment models. Barriers such as resource limitations and new reporting requirements persist, while payers demand evidence of the value provided before reimbursement.
These challenges, though formidable, are not insurmountable. A new era of payer-provider collaboration is the key to overcoming them. Through enhanced data exchange, collaborative governance and shared expertise, payers and providers can jointly deliver better health outcomes at reduced costs, creating next-generation patient experiences. This article delves into how this transformative landscape can emerge.
Embracing Radical Transparency to Break Down Silos
Healthcare, a highly fragmented and rapidly evolving sector, lags in meaningful payer-provider collaboration due to misaligned objectives. With a growing emphasis on consumer centricity, payers and providers are aligning their services to better cater to the unique needs of patients.
Greater transparency is paramount to achieving these goals. However, industry dynamics must first shift to favor this re-thinking of health systems worldwide. For payers and providers, this means working together to define the value in value-based care, aligning what matters most to patients and populations.
This can be achieved through collaborative advisory councils, among other things, enabling companies to assess capabilities and implement governance based on agreed financial and outcomes design. The fragmented nature of providers – in terms of size and competency – underscores the need for payer collaboration to develop the right contracting models and build appropriate care strategies. Simultaneously, alignment among executives, operations and clinical leadership can further set the right agenda for embracing true transparency.
Developing a Holistic Patient View through Data Exchange
Perhaps the most significant impact of greater collaboration is the development of a nuanced understanding of patients’ needs. Payers and providers can achieve this together through data exchange, creating a unified 360-degree view of patients applicable across multiple process areas.
Already, data contextualization platforms are enabling providers to seamlessly integrate and contextualize healthcare data, simplifying processes, delivering superior business outcomes and building trust with members and providers. Data from payers can add further depth to insights gleaned from integrated and holistic healthcare data, unifying member journeys and better serving those with complex healthcare needs. This openness can augment existing data and analytics capabilities within healthcare.
Re-defining Patient-centricity with Next-generation Capabilities
From this collaborative vantage point, the possibilities for value-based care are endless. Payers and providers will be empowered to build next-generation care and population health management capabilities, ushering in an era of enhanced self-care and preventive care for better outcomes.
Organizations can harness new technological advancements to re-define patient-centricity. Tapping into rapid advances in telehealth-related services, for example, can drive enhanced outcomes for payers, providers and patients alike. A recent collaboration with a telehealth platform saw one payer partner reduce emergency department visits by 40.5 percent.4 Meanwhile, next-generation wearables and remote monitoring tech can further enhance technology’s role as a health facilitator, creating new opportunities for prevention and self-care.
Collaboration also unlocks the full transformative power of Generative AI (Gen AI), addressing payer organizations’ key challenges, such as reducing administrative costs and enhancing personalized experiences for members. Merging payer and provider datasets could prove a game changer in driving personalized care at a community level, with Gen AI adoption (in healthcare) expected to outpace other industries – projected to register a compounded annual growth rate of 85 percent through 2027.5
Partnering to Improve Patient Care
As the health industry moves toward value-based care, providers and payers must be ready to address key challenges that hinder progress. Collaboration is integral to ensuring patient-centricity thrives. This collaborative sentiment goes far beyond the payer-provider relationship, with leading service providers stepping forward to offer comprehensive clinical and care expertise, unified experiences and access to artificial intelligence and analytical capabilities. In doing so, a landscape defined by high touch and high-tech care is swiftly emerging, driving better health outcomes across all stakeholders.
References
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https://www.bain.com/insights/what-will-it-take-for-physicians-adopt-value-based-care-snap-chart/
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https://www.cms.gov/blog/cms-innovation-centers-strategy-support-high-quality-primary-care
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https://www.healthcare.digital/single-post/value-based-care-what-exactly-is-it-and-how-much-money-is-being-invested-into-vbc
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https://www.fiercehealthcare.com/digital-health/long-term-plans-hybrid-care-begin-take-shape-health-systems-and-digital-platforms