Out of all of this, the issues with a fee-for-service model within health care have become more evident, and in response, the value-based care approach has moved from concept to implementation in health systems across the U.S. “The transformation to value-based care is well under way,” according to Michael Porter and Thomas Lee1.
While the movement to value-based care has momentum, there is also opportunity for health systems to pursue different models that allow them to compete in the marketplace while successfully pursuing the “Triple Aim” of health care. The Institute for Health Care Improvement originated the concept of the Triple Aim: improving the patient experience of care (including quality and satisfaction), improving the health of populations and reducing the per capita cost of health care2. Pursuing each of these aims can be done using a variety of approaches. So how should health systems choose their approach to increase the value of care and successfully compete in the marketplace?
Along with health leaders’ examination of local market dynamics and ways to leverage their systems’ relative strengths, a concentration on what payers are looking for is a key factor in deciding which model is the best fit. While the federal government funds a large portion of health care spending through Medicare and Medicaid, with clear directives issued to providers utilizing value-based care models, health systems also should look at another large payer segment — employers — to properly assess demand. In 2015, private health insurance via employers was “the largest payer of health care in the United States, accounting for 33% of total health care spending.”3 Understanding employers’ health benefit strategies and being positioned to meet their needs can be a key to success for many health systems.
Willis Towers Watson’s 2017 Emerging Trends in Health Care Survey, representing 467 employers with at least 500 employees, explores the actions that U.S. companies have taken are planning to take to design and implement progressive health care benefit strategies, combat escalating costs, and improve employee health and productivity. Employers’ priorities over the next three years show clear opportunity for health systems to implement effective value-based models to meet the needs of employers as plan sponsors.
Three employer priorities to consider while developing value-based care programs
Among the priorities that employers communicated through our survey, three stand out as areas that can best help guide the development of health systems’ value-based care programs.
Total well-being
More than two-thirds of employers find employee well-being to be extremely important. Increasingly, employers are moving beyond a traditional health focus of well-being to also include other elements, such as financial, emotional and social well-being. Further, qualitative comments in the Emerging Trends in Health Care Survey data indicate a desire to emphasize wellness as part of a total well-being strategy.
While improving health and well-being is a pillar of value-based care, whether a health system sets up an accountable care organization, center of excellence or a near-site clinic, communicating the positive impacts of these models on total well-being is key. Demonstrating how a value-based model improves not only physical well-being but other elements as well will be an important consideration for a large majority of employers.
Improve employee navigation support
While developing value-based offerings, employers and health systems alike must identify new forms of employee support to realize the greatest benefits. In particular, most value-based models require individuals to choose between higher-quality or lower-cost providers. Employers are seeking improved employee navigation support to help employees with these decisions. Over the next three years, almost half of employers note navigation support as an extremely important priority.
While there is stiff competition when it comes to quality of care and cost, health systems that can integrate navigation support into their offerings will set themselves apart from the pack with their value-based offerings.
Focus on health care access and delivery
Many employers are prioritizing health care access and delivery over the next three years (57% recognize it as extremely important) and are evaluating from among a number of delivery options. New delivery models include telemedicine, onsite/near-site clinics, accountable care organizations and direct contracting. These options not only each have strengths that can improve health and cost outcomes if selected and implemented appropriately, but create improved employee engagement and perceptions of value of the employers’ benefit plans. Health systems that can clearly articulate a strong value proposition for employers for new health care delivery models will have an advantage. These three priorities taken from our research — total well-being, navigation support and alternative delivery channels — are important foundations for a health system’s direct-to-employer strategies.
In conclusion, by understanding and improving focus on employer needs, health systems can continue to evolve value-based care and improve care, health outcomes and costs – while gaining momentum in the health care marketplace. By considering the specific priorities above, health systems can ensure that their offerings are effective in meeting considerations of well-being, navigation and delivery, further ensuring success for today and well into the future.
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1“The Strategy That Will Fix Health Care”; Michael E. Porter and Thomas H. Lee; Harvard Business Review, October 2013
2IHI Triple Aim Initiative; Institute for Healthcare Improvement; http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx
3http://content.healthaffairs.org/content/early/2016/11/22/hlthaff.2016.1330.full.pdf+html
Anne B. Martin, Micah Hartman, Benjamin Washington, Aaron Catlin and the National Health Expenditure Accounts Team
National Health Spending: Faster Growth In 2015 As Coverage Expands And Utilization Increases
Health Affairs published onlineDecember 2, 2016
