How to accelerate value-based care despite looming healthcare crisis

Align definitions of value-based care around member experience

Despite the fact that the term “value-based care” has been in use for over 15 years, different organizations may prioritize differently in their value-based efforts, lending a variety of definitions to the well-worn phrase.

“I've been on the payer side for many years, and a lot of times, providers and health plans talk past each other and have different definitions or different real strategic intent for what they mean by ‘value-based care,’” Antonucci said.

Many conversations around value-based care center on affordability or quality. But Antonucci presented another option. He emphasized that experience should be the focal point of payers’ value-based care initiatives and priorities.

“You can't just focus on quality from my perspective. To what end are you going to focus on quality?” Antonucci asked.

Prioritizing member experience can give quality metrics more meaning. Affordability without a positive member experience is not meaningful; it is simply cheap care.

Retailers’ efforts to enter healthcare exemplify both the benefits and challenges of centering member experience in healthcare. Companies like Amazon, Walgreens, and others have embraced healthcare consumerism and leveraged their existing processes, partnerships, and tools to deliver convenient, affordable care.

While many retailers have not achieved sustained success in the healthcare space, Antonucci applauded these efforts to use technology to improve the member experience. That kind of pressure on the rest of the industry to evolve and adopt a consumer-oriented mindset will be essential for weathering the upcoming crisis.

Centering on member and provider experience may go beyond value-based care efforts, Antonucci added. It may be a culture change that payer organizations need to undergo. At Providence Health Plan, the organization centralizes member experience in its company promise: “know me, care for me, ease my way.”

The first step of any value-based effort should be to know the patients and the doctors well. Those efforts inform payers about how best to care for these two populations. Then, the final piece is convenience: looking for ways to make it easier for patients to make the right decisions and achieve positive outcomes. A health equity mindset should characterize each step.

As part of expanding the vision of value-based care beyond affordability, it is crucial to share success stories, Antonucci added. Providence Health, for example, pursues multiple pilots to assess technologies and solutions that help providers with their workflows. When an endeavor is successful, the organization sometimes makes it available to other healthcare systems.

Keep the provider journey as an aim of value-based care

The medical profession has transformed significantly since the phrase “value-based care” was coined in 2006. Diseases and treatments have become more complex and more long-term. Administrative tasks are more involved. Technologies designed to alleviate these issues, while useful, have a steeper learning curve.

The high level of burnout among providers is a testament to these changes, but it also signals that doctors, nurses, and other care providers have not been prioritized amid this systemwide transformation. Since these roles form the keystone of the healthcare system, a poor provider experience has significant downstream effects.

Provider experience should be an established component of value-based care, Antonucci argued.

Value-based care has expanded from the Triple Aim, developed in 2007, which established three goals: population health, patient experience, and per capita cost. It was not until 2014, when the Quadruple Aim was introduced, that provider experience was included. The modern Quintuple Aim, presented in 2016, combines provider experience and patient experience into one goal.

Due to the model’s rapid metamorphosis over the course of less than a decade, it may be understandable that healthcare organizations find themselves emphasizing different components. It may also explain why the provider experience aim, now combined with member experience, might not get the attention it deserves.

This is where provider-sponsored plans present some structural benefits. Situating the health plan within a provider organization can streamline communication and optimize payer-provider workflows.

“One advantage that we have as a provider-sponsored plan, and others do, is that you've already got those communication channels wide open,” Antonucci shared.

Centering provider experience will also help payers respond to providers’ hesitancies about entering value-based contracts. Antonucci recommended making front-end investments in pilots to address providers’ concerns about the financial hurdles of starting a value-based care model and then sharing successful strategies.

“We, payers and providers, must learn to speak a common language by defining shared terms, objectives, and most importantly, fostering open dialogue. If we can do this, we can align on what truly matters: the health and wellness of patients, members, and communities,” he said.

Leverage existing technologies

Technology alone cannot solve the problems that are developing into a healthcare crisis. However, it will be key to the solution and has already proven essential to payers’ strategies.

In particular, ambient listening tools have been trending at conferences like AHIP. Anecdotally, Antonucci shared that his own doctor uses a tool that records the first eight to ten minutes of his session and then automatically populates his chart with the data. His doctor told him that the ambient listening tool lightens his evening workload by 45 minutes to an hour.

Dialogue around these technologies has largely emphasized the potential for reducing providers’ administrative burdens. However, Antonucci stressed that in order to accelerate value-based care progress, the conversation should pivot to consider the benefits for the provider and health plan member together.

For example, the experience of having a doctor’s full attention due to ambient listening technologies may affect the patient-provider relationship. Payers and providers need to discuss that change and ensure that it contributes positively to a whole-person approach to care.

However, technology can only go so far in accelerating value-based care.

“While technological advances play a pivotal role in accelerating value-based care, it is imperative that the implementation of technology, especially with AI in healthcare, is human-led,” Antonucci underscored. “These advances are intended to provide support with workflow, cost reduction, and direct more resources to patient care, not replace the human care needed to positively impact patient outcomes.” 

Bring employers into value-based care efforts

Given that employers are often left footing the bill in healthcare, Antonucci mentioned that their participation in value-based care is crucial.  

As providers continue to rebuild revenue from the coronavirus pandemic and struggle with rapidly growing costs, they will pass on spending increases to employers, particularly large, self-funded employers. Already, employers and private plans pay over $2 for every $1 that Medicare spends.

“Part of this, too, is making sure employers step into that value-based care equation in a bigger way,” Antonucci emphasized.

“As significant purchasers of healthcare coverage, employers wield considerable influence in shaping the future of healthcare. By collaborating with providers who deliver measurable results for their employees, they can help drive demand for value-based care while enhancing patient experiences.”