Division among employers prolongs their inability to alter the healthcare system, but by acting together, value-based care will begin to spark change, said Lauren Vela, MBA, senior director, Member Value, Pacific Business Group on Health.
Division among employers prolongs the inability to alter the healthcare system, but by acting together, value-based care will begin to spark change, said Lauren Vela, MBA, senior director, Member Value, Pacific Business Group on Health.
How can employers help move the healthcare system away from fee-for-service and to value-based care?
So, this is a really important goal, and we need to all do this. I think that there are many things they can do—the number one thing they can do is work together. Employers are fragmented, sort of, from a health plan’s perspective and the provider’s perspective—divide and conquer. We are divided and conquered, if not working together. So, we encourage our employers to ask for the same things from their health plans and their provider partners to have some core standardized measurement, some priorities in common. It’s really difficult for a provider organization to start practicing in a value-based way if only a small percentage of their patient population is paying for them to do that. So, I would say acting together is the number one thing they can do.
Are there particular payment reform models that employers favor?
Honestly, it depends on the employer. So, amongst our membership, we have some employers who are very invested in the Centers of Excellence program—that’s more of a bundled payment methodology—but we also have employers who are very invested in an ACO [accountable care organization] type of approach, which is more population health, shared savings, and sharing risk for total cost of care. So, I think that it really depends on the employer and their specific strategy. I would also say that we have some employers who invest in both of those strategies, because it depends on where they have headcount—so, in some geographies an ACO might make sense, but in some geographies it doesn’t based on their headcount and Centers of Excellence makes more sense.
I think it’s really important though, in talking about a bundled payment, that one thing that we’re always clear about is a very, very, very well-priced surgery, that wasn’t supposed to happen, is not a bargain.