September 4, 2018

Shifting to Value-based Care Easier Said than Done

By Peggy Fischer


Personalized Advocacy can pave the way

Value-based care - which rewards the quality of care delivered, not quantity - holds a lot of promise for employers and consumers demanding better healthcare experiences and outcomes at lower cost. But promise is one thing and execution another. Moving from fee-for-service to fee-for-value represents a monumental transformation for providers.

As former National Health IT Coordinator Farzad Mostashari, MD, explains in an interview with Oliver Wyman: “The commitment to this shift to value-based models extends from the provider community to both public and private payers and large employers.” But to fulfill this commitment, he argues, providers must do more: “Transforming one's practice - from adjusting workflows to utilizing technology resources - to excel in alternative payment models should be a primary focus for providers.”

New Capabilities Required to Succeed in Value-based Care

Making the shift represents more than adjusting workflows or using technology, however. At its heart, the move to value-based care demands a fundamentally different approach to healthcare - one that enables providers to:

    Understand and reach people before they are patients. Providers need the ability to identify, understand and reach all consumers who need healthcare support—not just the costliest, sickest or highest risk, but individuals who may be rising risk or even low risk today.
    Engage and influence people outside of the walls of healthcare - before, during and after visits. The vast majority of decisions that impact health and well-being are made outside of the doctor's office or hospital, where providers can't easily reach.
    Ensure continuity of care as a person transitions across different care settings and providers. Consistent communication and coordination is critical to keeping people on track as they move from hospital to clinic to home.
    Strengthen their relationships with patients. Value-based care seeks to elevate the role of the patient to a true partner in their care with the provider, i.e., a fully informed and empowered decision maker.

Physicians and Health Plan Executives Are Not Optimistic

It's a shift that physicians and health plan executives are not optimistic about making successfully. In fact, they are less confident in making the move to fee-for-value than they were a year ago, according to a recent survey by Quest Diagnostics. In 2017, 45% of health plan executives said physicians do not have the tools they need to succeed in value-based care. This year, that percentage has spiked 12 points to 57%, according to the survey. And, a whopping 90% of physicians say they don't have adequate staff time to manage the administrative demands of value-based care models.¹

Electronic Health Records Not Sufficient

A major barrier to progress is the primary technology used for patient care. Not only are Electronic Health Records (EHRs) “closed” systems that don't easily exchange patient data with other EHRs or systems, but they are also limited to storing “structured data” - and the vast majority of health data is unstructured, e.g., audio files, images, scanned documents, etc.² Perhaps most important, with an average of 15 minutes with each patient, physicians simply don't have the time to capture and document patient life context, information that is critical to better outcomes. Ironically, the demands of EHRs also have eaten into physician time interacting with patients. It's not surprising that more than 70% of health plan executives and physicians say EHRs do not store enough information to provide patient care.³

Other barriers cited by physicians and health plan executives include lack of standardized quality and performance measures, and lack of alignment regarding the use of technology in patient care.

Personalized Advocacy Fills the Gaps, Paving Way for Value-based Care

Rather than expect already over-burdened providers to fill the gaps, employers across all industries are turning to a new employee health and benefits model - one that works in conjunction with providers and payers to augment their capabilities, addressing the missing pieces needed to improve outcomes, both health and financial.

Personalized Advocacy is a "people plus technology" approach that works on behalf of employers and in partnership with their members, providers and payers. It personalizes population health, empowering individuals, families and providers to make better healthcare decisions. And personalized advocacy provides a vital link between patients and providers across the healthcare system, strengthening this relationship to improve outcomes.

Learn more about personalized advocacy and how it works. Read the paper today.



² (Oct 2013). Datamark, Healthcare Content Whitepaper.