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Navigating the Rocky Waters to Value-Based Healthcare

Allison Inserro
Problems in healthcare seem overwhelming, with at least 17 different factors cited as driving unsustainable spending, according to a presentation at the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts. Two executives from Precision for Value LLC spoke about “Charting the Shifting Value-Based Healthcare Landscape: Emerging Developments for 2018 and Beyond” and offered their view on what healthcare companies can do to succeed.  
Problems in healthcare seem overwhelming, with at least 17 different factors cited as driving unsustainable spending, according to a presentation at the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts.

Two executives from Precision for Value LLC, Jorge Fant, MPH, and Elizabeth Oyekan spoke about “Charting the Shifting Value-Based Healthcare Landscape: Emerging Developments for 2018 and Beyond” and offered advice about what healthcare companies can do to succeed.  

Fant described the healthcare landscape as “the perfect storm for change.” The question is, he asked, who is going to make the push to make it happen? He reviewed early attempts that left many dissatisfied, from initial payment bundles, to commercial pay for performance programs, to newer narrow network programs, which are not yet mainstream.

“There's a lot to believe that the managed care industry has failed us,” he said. But he thinks the industry may have reached the “tipping point” to value-based care, with heavy credit given to the ultimate payers: government and employers.

He noted several barriers to value-based care, including:
  • Technology and analytics, where interactive interoperability means not just getting the data but being able to analyze it.
  • Finances and cost, meaning both the financial investments required by small- and mid-sized provider groups and the size of corresponding incentives.
  • Performance measurement, which he defined as the lag time between change and measurement, a lack of standardization, as well as no uniform insurance company reports on performance.
  • Behaviors and accountability, stemming from an overall resistance to change, complexity in understanding various relationships, not fully understanding who owns which responsibilities and a lack of patient and provider engagement.
Precision for Value has come up with its own acronym called TEDs, created by Oyekan, and by that they don't mean the ubiquitous public speaking series of the same name. In their view, TED stands for trends, entrants, and developments in healthcare.

Based on this TED model, they see 6 areas focused on transforming healthcare and bringing value.

Alternative care delivery models
Under alternative care delivery models, they group retail clinics, social determinants of health, and the government, through the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA.  

Retail clinic examples include Target, Walmart, CVS-Aetna, King Soopers and others, operating outside conventional physician offices. Once thought of as simply a place to get a vaccination, retail clinics are coming up with new business models of primary care. The impact is that payers may be able to leverage lower cost and have more control, but doctors may face lower revenue and the loss of patient continuity. Pharmacists may see expanded roles with care management and care coordination.

Social determinants of health are getting increased attention, as it’s a way to affect health in ways that do not take place inside of a doctor's office. Examples include ProMedica and the American Hospital Association, Aetna, and more. Pharmacists could leverage community data to identify health patterns.

Despite complaints from providers, MACRA  is not going away anytime soon and will continue the shift from volume to value, FANT said.



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