We are on the path to a value-based care system. Value-based care underpins the Affordable Care Act and is a guiding principle of health systems in the Nordics and Germany.
At its core, value-based care is modeled on the idea that care should be built around patients and their quality of life. A transition from the traditional fee-for-service model (which pays providers for treatments), value-based care helps companies achieve relevant, tangible outcomes and improve the cost of care.
In our recent research, we found that 60% of the organizations surveyed hadn’t taken a single step towards value-based healthcare in the last 2 years. But among those that have, a group we will call value-based care Leaders, the Leaders have seen improved care across the board. For example, 55% of Leaders say that patient readmission rates and complications from care have reduced, and a whopping 63% of Leaders saw an improvement in clinical outcomes.
In the end, value-based care Leaders are more likely than others to see care improve. We know from working with these Leaders that they have taken the following four actions to further their value-based care journey. All healthcare companies can follow these guiding principles to chart their course.
1. Take the plunge. Value-based care requires changes across the board. Culture, processes and maybe even business structures must be updated. This can seem daunting, but don’t freeze in fear, simply dive in. We know that organizations making the most progress don’t let those issues stop them, they’ve found small-scale innovation generates and builds upon its own momentum, making more progress possible. They’re also seeing results, fast. Care costs are declining, regulators are endorsing the benefits, and patients are happier.
2. Organize care around patients. It is essential to rethink, and reorganize, how care systems work. Value-based care Leaders treat patients as partners, and we have seen that real gains are possible when companies focus on patients.
Take Banner Health for example. Their employed physician group with more than 1,300 physicians and advanced practitioners across more than 65 specialties is transforming the delivery of care through the development of a Patient-Centered Medical Home (PCMH). Through PCMH, they are organizing care around patients, working in teams, and coordinating and tracking care over time. The result has been a reduction not only in avoidable surgery admissions but also reduction in medical costs.
3. Harness the right technology. Technology will make healthcare in 2025 feel very different to healthcare in 2018. We will see smarter mobile technology, machine learning, and telehealth capabilities. The organizations making the biggest strides towards value-based care are seeing the benefits. Nearly three quarters of the Leaders in our research are successfully using technology to generate insights about their patients. They’re also seeing other benefits, including better communication with patients and professionals, and increased collaboration with outside partners. In the end, that translates to fewer prescription errors and shorter waiting times.
4. Get a grip on data. Value-based care ushers in a complete rethink on data. Leaders use a wide range of data to shape patient care plans and prioritize patient-reported information. But we know that they can go further. Our experience of mining Dark Data – data that’s either discarded or not considered for use during the primary data analysis phase of any given project – shows the wealth of insight that healthcare companies could use to target care much more effectively.
For example, PA is working with a Medical Society that is utilizing Dark Data to provide insight into new product development. By leveraging existing data, companies can engage physicians to improve care pathways, improve patient experience, and reduce overall costs of new medical devices. It is a win for the device companies as it reduces product development costs, and a win for healthcare payers who are seeing lower costs. Providers and patients both benefit from adherence to treatment plans and better outcomes. But Dark Data utilization requires trust and collaboration. Consumers are rightly sensitive about where their personal data is, and who is using it. The industry must set strong data standards and create the narrative that reassures patients.
Rather than just providing products, today’s healthcare leaders are focused on delivering solutions that benefit the entire ecosystem. Value-based care is quite simply a defining principle in our current healthcare ecosystem. We understand that organizations are receptive to the approach, and value-based care benefits are tangible to those receiving and delivering care. If healthcare systems want to see progress, they can surely implement the four guiding principles described above. Those that do will be well positioned for the continued disruption that is coming and those that don’t will find the path to success even more difficult. New entrants into healthcare such as Amazon and Walmart, plus the recent large-scale mergers that have dominated the news, will continue to challenge the status quo and change the traditional value chain of healthcare. In the end, the companies that take action will survive.
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Bret Schroeder is a healthcare expert at PA Consulting and co-author of the value-based care report “A More Human Approach to Healthcare.” Bret has over 20 years of business strategy and operations experience focused on helping companies leverage technology to improve business performance.