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Employing Value-Based Care: An Industry View of Obstacles, Applicable Strategies for Efficient Implementation

Matthew Gavidia
Innovaccer’s survey-based report titled, “The Science of Value-based Care: An Industry View,” details the current state of readiness of healthcare organizations in employing value-based care, while also providing tips on how minor changes in one’s system framework can contribute to clinical excellence and technical efficiency.
Innovaccer’s survey-based report titled, “The Science of Value-based Care: An Industry View,” details the current state of readiness of healthcare organizations in employing value-based care, while also providing tips on how minor changes in one’s system framework can contribute to clinical excellence and technical efficiency.

In an interview with The American Journal of Managed Care® (AJMC®), study author David Nace, MD, chief medical officer at Innovaccer, stresses that healthcare is at a crossroads, where health systems are struggling to follow their patients and their needs across various care settings. “Apart from adopting unified patient records, healthcare organizations need to ace their strategies around provider and patient engagement, promoting team-based care and incorporating non-clinical factors in their care delivery processes to improve their health outcomes,” said Nace.

Innovaccer sought to understand the overall perspective and state of readiness among providers, payers, and healthcare leadership in implementing value-based care to see what challenges organizations are faced with in delivering better care, and what ideal solutions can resolve these issues. The analytical basis of the report included 25,000 responses from the total data sample collected based on the cumulative responses from 2900 healthcare executives.

As highlighted in the report, a 2015 announcement by the Healthcare Transformation Task Force (HCTTF), an industry group representing healthcare payers, providers, purchasers and patient organizations, stated that HCTTF payer and provider members aspire to have 75% of their respective businesses operating under value-based payment arrangements by the end of 2020. Among the surveyed healthcare executives for Innovaccer's report, over 45% responded that they understand value-based care and have implemented some of these elements in their organizations, but when polled on the progress of their value-based performance or risk-based transition, most answered that they are still in the pilot phase.

This pales in comparison to the most recent report by HCTTF, in which their provider and payer members had over half (52%) of their business in value-based payment arrangements at the end of 2018, up from their first report of 30% in value-based arrangements in 2015. 

The major obstacle reported by healthcare organizations in Innovaccer's survey-based report was the lack of structure in place to integrate their patient data. Technology served as an extensive barrier to employing value-based care, as over 50% of respondents stated that implementing the right analytics with the use of the right technology is the most crucial element in a successful transition. While they are aware of this and detail their interest in artificial intelligence, 42.89% reported that they do not know how to implement these technologies.

As the report describes, US healthcare has an unsustainable model burdened by high costs and poor outcomes. To assist healthcare organizations in successfully implementing a value-based system, Innovaccer devised 12 value-based levers that address 6 main dimensions relating to managing overall healthcare costs: cost and utilization, network, contract, quality, risk, and attribution mix.

Additionally, Innovaccer highlighted their Connected Care Framework construct, which aims to promote care and population health management activities based on insights derived from a unified patient record system. The framework is designed as a way to empower physicians, leaders, care managers, and patients to achieve clinical and non-clinical goals for better health. “It is different from the existing frameworks due to the foundational unified patient records, that connect patient-level data from labs, EHRs, pharmacies, claims, hospitals making individual data truly interoperable for providers, payers, and employers who need it from across the healthcare continuum,” said Nace.

The court proceedings surrounding the Affordable Care Act, or Obamacare, over its constitutionality has caused unrest in the healthcare system, but Nace maintains that it is in the best interest of healthcare organizations to remain committed to the goal of value-based care. “The common goal here is to mitigate the rising cost of healthcare, which can be achieved with reasonable preventive care and the overarching idea of a connected care framework,” said Nace.

Nace said that by utilizing the Connected Care Framework, health systems can provide their physicians with point-of-care insights, their care managers with automated care pathways, and their administrators with analytical dashboards to track their expenditure and utilization. “This complete array of solutions saves time and dollars for healthcare at the same time. Health systems can excel in today’s value-based environment by keeping their costs as affordable as possible for the patients,” said Nace.

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