Value-based health care continues to transform the way American businesses and consumers receive and pay for health care.
Value-based health care is designed to be relatively simple: When providers are incented to deliver results, rather than simply bill for services, employers save on premium costs and patients receive better treatment and stay healthier over the long term.
The approach is opening new doors for employers to provide access to quality benefits while saving on the cost of care. Physicians are supported by a system that truly allows them to put patients first. Consumers benefit from evidence-based care. And the numbers show its impact.
But how can you help ensure you are receiving the most from value-based health care strategies?
In 2016, UnitedHealthcare had $53 billion in value-based contracts in place, approximately 42 percent of it provider contracts, up from 21 percent in 2012. These contracts are designed to help deliver higher quality, lower costs and a better overall experience. But these contracts are just the outcome of a greater effort.
Value-based health care is a collaborative vision, and the best possibilities arise from a model grounded on strong partnerships. We’re working with care providers to keep people healthier and help them pay for value rather than volume, and we’ve shaped our organization to help support this goal. We offer dedicated teams to Accountable Care Organizations (ACOs) and providers that include clinical, technical and financial subject matter experts; have built one of the largest and longest-running physician designation programs; and facilitate peer-to-peer discussions for physicians at annual ACO summits. The power of these relationships is the most important thing we contribute toward the transformation to value-based health care.
Partnership between providers
There are more than 900 ACOs active in the U.S. today.1 These organized groups of providers’ work together serving a designated patient population and are financially incentivized to help produce good patient results. This collaborative and interdisciplinary approach is designed to provide better patient results, and also realize savings through greater efficiencies and focus on preventive care.
With access to regional and national data, to financial resources, and to broad networks of providers and employers, health insurers are ideally placed to join with ACOs, health systems and medical groups, broadening the depth and scope of health care transformation.
1. Look for strong relationships between health plans and providers
Insurers, ACOs and provider groups have a mutual financial and philosophical stake in taking a different approach to health care. A value-based approach formalizes this common interest into a risk- and reward-sharing agreement. Health plans are in a position to incentivize providers to meet cost targets by sharing resulting savings. The role of health insurers is moving away from simply negotiating discounts with hospitals and physicians toward becoming a partner who supports and shares their financial goals.
Case study: WESTMED Medical Group
Drawing upon analytics tools from Optum, WESTMED, a physician-led ACO, improved nine of 10 health quality metrics in its first year, ranging from patient satisfaction to reduced costs. Patients improved medication compliance, signed up for more routine screenings, and spent less time in emergency rooms and hospitals.
Ideally, health insurers structure their organizations to include clinical, financial and technical subject matter experts who consult with ACOs and health systems like WESTMED. Insurance companies are privileged with access to extensive data. Sharing this data and offering analytics is one of the most effective ways health plans support provider success. Targeted analytics play an equally important role for employers.
• Craft evidence-based decision support guidelines
2. Seek opportunities to partner with your health plan
Value-based health care is all about the patient. Data and analytics play a vital role in applying this principle to employer benefit design. Working together with employers, insurers can use claim data to help target specific employee conditions and identify highest-value opportunities to treat them. Spine and Joint Solutions are just one example.
As data on aging and obesity rates shows, musculoskeletal procedures are on the rise, leading to an expected 500 percent increase in knee replacement surgeries by 2030.2 In response, UnitedHealthcare launched a value-based care payment for knee, hip and spine procedures that focuses on quality patient care and better outcomes. The program gives employer-sponsored plan participants access to Centers of Excellence whose physicians have demonstrated better outcomes and fewer complications.
Analytics can similarly identify unique health risks within specific employee populations and design networks tailored to those populations. Data, however, can only do so much. Value-based health care ultimately hinges on employee, plan member and patient adoption.
3. Remember that employee comprehension and engagement help deliver the real value
In order for value-based care to deliver on its potential, employees and plan members need to feel incentivized to choose quality care. Structuring benefit plans that help drive employees to quality, high-value providers is a start. Helping employees recognize and choose these providers is essential for ongoing success.
Communication and engagement efforts help make sure:
- Employees trust they're getting access to high value providers
- Employees have support making decisions
- Cost information is easy to understand
- Care options appear relevant to their needs
- Employees have easy access to personalized account information
- Paying for health care is packaged into a familiar, consumer-friendly experience
Value-based health care: Truly a team effort
Positive systemic change requires participation at every level, from large provider organizations to individual employees. Because health insurance companies have touchpoints within every phase of health care delivery, they have the potential to facilitate this bigger conversation.
For more information about value-based health care, contact your UnitedHealthcare representative.
1Muhlestein, D., Saunders, R., & McClellan, M. (2017, June 28). Growth of ACOs and Alternative Payment Models in 2017 [Blog post]. Retrieved from http://healthaffairs.org/blog/2017/06/28/growth-of-acos-and-alternative-payment-models-in-2017/
2Weiss AJ (Truven Health Analytics), Elixhauser A (AHRQ). Trends in Operating Room Procedures in U.S. Hospitals, 2001—2011. HCUP Statistical Brief #171. March 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb171-Operating-Room-Procedure-Trends.pdf.