Payers have begun to transition to value-based care reimbursement from the more traditional fee-for-service payment system. Executives and financial experts are begrudgingly understanding that it will take longer than expected to adopt the new payment structures. Many obstacles will impact the timing and effectiveness of this transition. Payers should follow some key best practices.
Evaluate the patient population
Steven lash San Diego explain how we can move to value-based care reimbursement effectively, payers will need to understand their subscriber base to understand the type of care and preventive services that will be required from the provider network. The results of this analysis can be communicated to relevant medical facilities to establish appropriate treatment for each patient.
Key strategies payers should include patient risk stratification and population health management analytics. Payers could help inform providers on which members are in need of greater engagement in their chronic disease management. Payers should follow Medicare’s lead and pay for a Chronic Care Management program.
Improvements in hypertension, weight management and sugar control show that it will have a positive impact on patient outcomes, but that usually takes years to benefit the patient and ultimately benefit the overall cost. This of course, is the payer conundrum since patients can change their health plans annually so the payer that has paid for these programs may not reap the benefit.
Passing the financial risk to providers should be done slowly
An important component for moving to outcome-based care is to introduce financial risk gradually. A Carrot and Stick approach is a radical change for providers and cannot be rushed into the provider community. When providers partner with payers through a risk sharing model (aka value based reimbursement), they’re often required to assume more financial risk as opposed to payers taking on more risk in a fee-for-service model.
Quality measures should fit existing provider patient care goals
Healthcare providers often have their own quality improvement goals for their patient population and as of late a standardized set. Payers could effectively transition to value-based care by aligning their quality measures to fit existing goals of their providers. This means that instead of forcing providers to adhere to differing quality metrics between public and commercial health plans, payers would implement their quality measures to align with that of CMS and the MACRA regulations.
Support healthcare delivery reform
Payers should follow Medicare’s lead and actively support changes in the healthcare delivery change. ACOs have been shown (when well run with good leadership and tools) to improve quality and reduce costs. In their infancy Medicare economically supported the formation of these ACOs. Additionally, models such as patient centered medical homes have also driven down costs and improved patient care.
Member engagement and empowerment
Steven lash San Diego explain how you can see the best results from value-based care reimbursement it will be necessary to invest in patient engagement and for patients to assume accountability for their health. Patients with the tools needed to make appropriate decisions in their healthcare shopping are more likely to choose more affordable options to the benefit of their wallet.