Healthcare organizations would be wise to concentrate on high-value care, optimize their networks, and focus on their core competencies.
The US healthcare system today finds itself at a unique point—an in-between phase in which it has begun to reward value over volume, but in which most reimbursement is still tied to the traditional fee-for-service system.
Nonetheless, most industry stakeholders seem to view a primarily value-based system as inevitable, though it’s anyone’s guess as to when we get there. In the meantime, many roadblocks stand in the way of the value-based future and are sewing doubts among some important constituents.
For example, a recent survey from American Academy of Family Physicians and Humana revealed that just 47 percent of participating physicians are actively pursuing value-based payment opportunities. That number was barely an increase from the 44% who reported interest in 2015.
Clearly there’s some apprehension about the effects of value-based care, but a better understanding could clear some of that.
As alternative payment models continue to evolve, it is certain that data and analytics will play a key role in shaping the value-based contracts that are essential components of these new reimbursement models. Here are 3 things healthcare organizations should consider to best leverage analytics for value-based care.
Focus on your core competency: For most front-line participants in the care-delivery system, patient care is what they do best, not data analytics. But in the realm of value-based reimbursement, data is crucial. As a result, healthcare organizations should examine ways they can leverage patient data to uncover new strategies and decision-making.
Of course, this is easier said than done, and many healthcare organizations lack the knowledge and resources to fully realize the value of their patient data. In such cases, it makes sense to first partner with companies that provide the necessary analytical talent and technologies, and then focus on finding the data and implementing the results. The best approach includes the right technologies (advanced analytics technology stack), the right team (data scientists, biostatisticians, data engineers, contracting specialists), and a feedback loop to implement the insights.
Concentrate on high-value care: In a system that ties reimbursement to positive health outcomes and cost control, it is imperative that healthcare organizations create strategies to drive care to lower-cost settings that provide equal or higher-value care. The analytics can provide the answers as to where these high-value opportunities are hiding, even if they clash with a doctor's first call.
Imagine a scenario in which a physician suggests that an elderly patient with comorbidities move into a long-term care facility upon discharge from the hospital. The analytics, however, may show that patients with this particular set of comorbidities have historically obtained better outcomes from in-home care. In this scenario, the physician—though well-intentioned—could have recommended a better treatment plan by following the data, rather than his own preconceived beliefs. Whether it’s a question of comparing drugs, devices, procedures, or facilities, data holds the potential to help payers and providers unlock opportunities to reduce costs and improve outcomes if it is trusted.
Optimize your network: In the world of value-based care, having the right network can represent the difference between success and failure. By collaborating with the right network partners, healthcare organizations can improve care coordination and population health management, while balancing costs with outcomes.
The key to establishing the right network is that all members must be aligned to improve care while reducing costs. Payers and providers can mine historical data to analytically design contracts that create this alignment. Contracts that properly align network participants’ incentives, in turn, can lead to a reduction in unnecessary hospital admissions and utilization of high-cost treatments.
The healthcare system has taken steps in the direction of its value-based future, but there’s still a long journey ahead. We have a strong idea of where we’ll end up, but how we’ll get there is uncertain. Still, healthcare organizations would be wise to begin by concentrating on these 3 elements.
Kevin Mehta serves as chief technology officer for Payformance Solutions. Mr. Mehta focuses on building data-driven, turnkey software solutions that provide payers and providers with the technical tools and resources needed to design, evaluate, build, measure and negotiate value-based reimbursement contracts.