Digital health can be an integral component to any value-based care (VBC) strategy. Without a virtual component, it's hard to imagine how population health leaders can improve quality, reduce costs, and achieve necessary scale and efficiency.
Here are three outsized opportunities for digital health to advance VBC and the obstacles that leaders should avoid in order to see long-term success in risk-based arrangements.
1. Scale access to team-based care
In VBC, services like chronic disease management, psychosocial support, and medication reconciliation are fundamental to managing increasingly complex patient populations. However, many physicians don't have the training to perform these tasks, most of which are also far below top-of-license.
Traditional in-person care models struggle to scale access to behavioral health practitioners, pharmacists, and care managers. Digital health platforms can address this gap and connect patients with the necessary care in-between visits and at their convenience.
Obstacle: Siloed care across digital point solutions
While digital health solutions can better enable wraparound care, lack of coordination among the care team could limit success. A patient today may receive a virtual visit through a vendor covered by their health plan, behavioral health support through a direct-to-consumer platform, and care management through their employer's benefits package. Important patient information such as medical history and medication lists can fall through the cracks as patients navigate from point solution to point solution.
Looking ahead: Providers, payers, and vendors will compete to platform these services and become a one-stop-shop to advance a VBC strategy.
2. Accurately identify rising and high-risk patients
Offering high-touch support to all at-risk patients undermines efforts to reduce the total cost of care and spreads organizational resources too thin. Digital health tools and data analytics have the potential to more accurately identify and proactively target patients who could benefit from lower-cost, higher-frequency virtual care.
Obstacle: Offering digital solutions for the healthy, wealthy, and activated
Many organizations offer wearables and digital platforms to improve patients' health—but often those solutions target the "worried well". Wellness solutions can ensure that low-risk patients remain low-risk, but digital solutions that will generate cost savings for the most vulnerable and costly patients should get priority. This could include remote patient monitoring for rising-risk polychronic patients or electronic patient-reported outcomes tools for cancer patients.
Looking ahead: The challenge will be identifying the right balance of investments in preventative and wellness solutions and those for high-acuity patients to maximize cost savings.
3. Navigate patients to higher quality, lower-cost sites of care
Reducing total cost of care requires directing patients to preventative services and lower costs site of care. Organizations have consequently partnered with vendors who provide on-demand video visits or chat messaging for care navigation or to manage low-acuity conditions.
For example, Cigna found that its virtual care users demonstrated 17% lower total medical costs and 36% net reduction in emergency department uses than its non-virtual users.
Obstacle: Sustaining patient engagement
While the cost savings of offering virtual visits are clear, virtual visits alone can't keep patients engaged throughout their care journeys. Organizations must invest in building out digital solutions along the care journey, from improved search to post-care services such as online follow-up scheduling, as incentives to drive ongoing engagement and help patients maintain healthy behaviors.
Looking ahead: Organizations who can build high-end consumer experiences to activate patients to continuously engage in lower-cost care options across the care continuum will have a competitive edge in risk-based arrangements.
The potential for digital health in VBC is growing as digital solutions start to capitalize on these opportunities. In a saturated market of nascent solutions, VBC leaders are tasked with identifying solutions with high utilization and satisfaction, and that demonstrate quality outcomes.
It's tempting to pick the solutions that offer quick wins, but VBC is a long-term play. Leaders would be better positioned if they prioritized digital solutions that can prove they've overcome these three obstacles—solutions that successfully bridge siloes, accurately target high-risk populations, and sustain patient engagement long-term.
Risk-based payment is progressing slowly but steadily for Medicare and Medicaid. The same can’t be said for commercial contracts, where it’s harder to find alignment between plans, providers, and employers on compressed timelines. But commercial risk is ultimately what will tip the industry toward value-based care or keep us in a world of hybrid incentives.
We believe that commercial risk is complicated, but possible. To chart the course forward, we’ve collaborated with experts from across health care and analyzed a national database of commercial claims. Access our resources to learn how you can push the industry toward a new cost and quality standard.
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