In the United States, the healthcare system grapples with soaring costs that are becoming increasingly unsustainable. To address this challenge, the industry has witnessed the emergence of value-based care as a transformative approach, garnering significant attention. According to recent data from the Centers for Medicare & Medicaid Services (CMS), national healthcare expenditure in the United States reached $3.8 trillion in 2021, accounting for approximately 18% of the country’s GDP. Value-based care is viewed as a promising solution to curb these escalating costs while improving patient outcomes.
Industry reports from Deloitte show that value-based care adoption is on the rise. In 2021, an estimated 26% of healthcare payments in the United States were tied to alternative payment models, emphasizing value over volume. This marked increase demonstrates the industry’s commitment to transitioning from the traditional fee-for-service model to value-based care, incentivizing providers to focus on patient health outcomes.
Elevating Healthcare Delivery through the Vision of Value-Based Care
Value-Based Care represents a delivery model that incentivizes healthcare providers, including hospitals and physicians, to prioritize patient health outcomes when determining compensation. By emphasizing patient well-being, reducing the impact of chronic diseases, and delivering evidence-based care, value-based care seeks to elevate the overall quality of healthcare delivery.
Building Framework for Value-based Care Success with the Quintuple Aim
At the core of value-based care’s success lies the Quintuple Aim vision, which encompasses five key elements: Outcomes, Affordability, Equity, Efficiency, and Accessibility. According to a study published in the Journal of the American Medical Association (JAMA), healthcare organizations that embrace the Quintuple Aim vision have reported improved patient satisfaction, reduced healthcare costs, and enhanced population health outcomes.
Challenges on the Path to Value-Based Care
The integration of value-based care; however, is not a smooth process and comes with its share of hurdles. The intricate nature of the healthcare ecosystem, opacity in operations, the rapid push for digitization, data latency, and fragmented systems have collectively hindered its widespread adoption. Overcoming these obstacles demands the establishment of streamlined, cohesive, and automated procedures that can optimize efficiencies and ultimately attain desired goals.
Risk-Sharing Agreements and the New Era of Collaborative Accountability
One crucial strategy in the journey toward value-based care excellence is the adoption of risk-sharing agreements. Payers and providers are increasingly entering value-based contracts, where payment aligns with clinical circumstances, patient outcomes, and the effectiveness of services rendered. According to a survey conducted by the Health Care Payment Learning & Action Network (LAN), 34% of healthcare payments in 2021 were tied to alternative payment models, highlighting the growing prevalence of risk-sharing arrangements.
Investing in Enabling Capabilities Is Table Stakes
To ensure sustained success in this transformative landscape, investment in enabling digital solutions and experience frameworks becomes paramount. According to a report by McKinsey & Company, organizations that invest in building robust data analytics capabilities and enhancing patient engagement have experienced up to 15% improvement in patient outcomes and a reduction of up to 20% in overall healthcare costs.
Value-Based Care Pivots on 7 Levers of Healthcare Excellence
To navigate the transformative landscape of value-based care successfully, healthcare organizations must embrace a strategic approach that prioritizes patient well-being and drives sustainable outcomes. The 7 Levers of Value-Based Care Excellence offer a comprehensive roadmap, encompassing key functional areas that empower providers to deliver exceptional care while optimizing costs. These levers act as guiding principles, enabling healthcare organizations to make meaningful strides in quality, affordability, equity, efficiency, and accessibility, thereby shaping a healthier and more patient-centric future. The 7 levers of healthcare excellence encompass:
- Stratification & Assignment: All value-based care begins with proper risk stratification and assignment. Stratification helps healthcare organizations identify the right level of care and services for distinct subgroups of members/patients. Assignment connects these subgroups into coordinated programs with the strategic care providers and internal care teams, ensuring repeatable care and communication patterns optimized for the individual’s health and cost of care.
- Outreach & Enrollment: Personalized care and wellness programs rely upon targeted outreach and seamless enrollment to ensure everyone has access to the quality care and prevention programs they deserve. Outreach is a proactive, personalized engagement strategy connecting individuals with valuable healthcare and wellness resources. Enrollment is a streamlined digital process that simplifies access to designed healthcare services and prevention programs.
- Goals & Interventions: Effective value-based organizations improve the health outcomes of their defined group of individuals through appropriate financial and care models. Effective programs promote wellness, manage chronic illnesses, and improve quality outcomes using cost-effective and non-duplicative services. Interventions address underlying medical, social, economic, and environmental conditions to improve individual outcomes and Quality Scores.
- Coordination & Navigation: Population health hinges on effectively coordinating and navigating patients through the healthcare ecosystem to optimize outcomes and improve the efficiency of care delivered. Care Coordination organizes a patient’s care across multiple healthcare providers, ensuring patient-centered and optimized care. Care Navigation is encounter-level orchestration with patients to help them schedule and keep medical appointments, get prescriptions, and troubleshoot health and wellness issues.
- Telehealth & Monitoring: Telehealth connects patients and clinical care teams using real-time or asynchronous channels, resulting in improved patient satisfaction and access to care. Monitoring supports cost containment by proactively managing an individual’s health and avoiding unnecessary healthcare utilization.
- Transition & Prevention: Value-based care relies on creating a virtuous cycle from transitions in care to preventive care to help people prevent disease exacerbation and maximize their health. Care Transitions refer to the coordination and continuity of healthcare when moving from one healthcare setting to another, such as the home, between healthcare practitioners, skilled nursing facilities, hospice, and more. Care Prevention aligns awareness with action for an individual’s overall well-being, thereby proactively reducing the risk of diseases, disabilities, and death.
- Outcomes & Performance: Successful value-based care relies upon improved visibility into healthcare providers’ earnings and the corresponding results they deliver for their patients. Outcomes management focuses on addressing at-risk populations by intervening with the right care at the right time to improve patient outcomes and reduce the associated cost of care. Performance management focuses on meeting patient-centered care, accountability, quality, cost management, and data management goals consistently and efficiently.
The Road Ahead: A Healthier, Value-Centric Future
The healthcare landscape is undergoing rapid transformation, driven by rising costs and an intensified call for enhanced patient outcomes. Notably, the prevalence of Value-Based Payment (VBP) models has surged, accounting for an increase from 30% to 40% of payments between 2016 and 2021. Inspired by the Quintuple Aim vision, the industry is reshaping its approach to prioritize patient satisfaction, curtail expenses, and amplify health outcomes. Even as complexities and challenges like data latency persist, innovative strategies such as risk-sharing, telehealth, and advanced data analytics are being harnessed to navigate these hurdles. Guided by the principles of the 7 Levers of Value-Based Care Excellence, the future of healthcare promises a shift towards quality, affordability, equity, efficiency, and accessibility, ensuring patient well-being remains at the core of its mission.
