Healthcare in the U.S. is heavily dependent on a payment model that prioritizes high volume over quality of care and the outcomes delivered. More and more healthcare organizations are questioning if that’s the right approach. Do more tests, more appointments lead to healthy populations or do we need a new payment model that focuses on those outcomes?
Value-based care is a payment model that puts the patient’s needs at the center of care rather than the volume of care. Transitioning an entire industry to a new payment model is a big effort and one where technology plays a critical role.
Arcadia’s Director of Enterprise Partnerships Nick Kamireddy and Tandigm Health’s Vice President of Business Transformation Mike Werner define how technology can help providers deliver care that’s needed when it’s needed most in Episode 5 of season 2 of The Schema, available now. Watch the full episode or catch up on the complete series.
Below we identify some of the industry’s biggest hurdles and how it can clear them to move forward with value-based care.
"One thing I learned from working in a bunch of different industries is everyone thinks they're the most inefficient, and healthcare really is. It's been eye opening to me to see the amount of work that goes into taking care of a patient, and it's not necessarily value-added work. There's a lot of administrative tasks of a primary care physician or a specialist or anybody in the healthcare ecosystem that really don't drive a lot of positive behavior change. I think what we need to do is to figure out a way to use our people at the top of their license, develop the processes that will help them provide the care for the right patient at the right time, and then use technology to inform the analytics that will help define the population that needs the most help."
— Mike Werner
Providers spend a lot of time wading through a sea of administrative tasks that don’t require their years of education and experience. This is an extremely inefficient use of resources for an industry that faces rising costs, patient outcomes that aren't necessarily improving, and staff burnout levels at all time high, thanks largely to the COVID-19 pandemic.
Werner believes that technology solutions exist that can reset the current day-to-day requirements of operating a healthcare system and will reduce a lot of that wasted time. New processes and analytics can really be the catalysts for a new way forward for identifying high-risk populations and delivering the right care at the time.
“It really comes down to taking apart the whole concept of value-based care and looking at it in its individual areas. The first thing that we like to focus on is population health, which is really the clinical strategy that underpins the care model, and then the value-based contracting, which is the economics that feeds the population health. As we are better at aligning the economics with the care for the patient, then the whole methodology and model will become more relevant.”
— Mike Werner
Right now, the overwhelming majority of providers use the fee-for-service payment model. Uptake of value-based care has been slow. We need a way to transition more providers to the value-based care payment model.
Werner says to drive adoption of value-based care, the industry has to take the model apart and look at its components. Once it can align the individual components—clinical strategy and value-based contracting—across the entire ecosystem of patient care, its adoption will increase.
“I look at all the different tools a practice has to face and I think about my kids. My kids play baseball, swim and play softball and I have an app and a communication tool and a different mode of communication for all those, and it drives me nuts to try to keep all that stuff straight. I can only imagine what it's like to do that for 12 hours a day with a bunch of patients in front of you that all require your care. So, we're going to get to the point where we are beyond all the different tools. We're going to get more pay-agnostic workflows so that when my mom or my dad goes to the doctor, they're getting the best care that they deserve at the right time.”
— Mike Werner
Healthcare touches everyone. Changing for the better offers a lot of exciting possibilities for various populations. Werner, who comes at the industry from a consumer perspective, asks why things are done the way they are. He equates some of the different processes in the healthcare ecosystem to aspects of his own life, such as maintaining significant and diverse communications tools for his children’s activities. This helps him imagine ways technology can support providers and make the administrative piece of their jobs easier so they can focus on care.
Werner envisions a time in the future where all of the different tools providers are required to maintain today, streamline into one. Pay-agnostic workflows will relieve some of the burden on providers who today are handling multiple payer contracts with divergent views of how healthcare should be provided. As a result, they will more effectively and efficiently deliver care to patients when they need it.