Research & Insights

Value-based care

The value-based care (VBC) movement — intended to shift the industry away from volume-based reimbursement — has been slow thus far. The next decade of value-based care must be different. Our research explores the barriers to value-based care and identifies key action steps that each industry stakeholder can take to drive progress.


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Tackle these challenges

Value-based care is an industry-wide strategy to improve population health and reduce the total cost of care. The transition from fee-for-service to value-based care requires two simultaneous transformations in healthcare:

  • Care model transformation: Redesign the care delivery model with a focus on primary care, prevention, chronic care management, and high-quality, low-cost episodes of specialty care.
  • Payment transformation: Redesign the reimbursement model with a focus on paying for the quality and appropriateness of care.

Partnerships in healthcare are fundamental to the successful implementation of value-based care models that can reduce costs, address health inequities, and optimize patient outcomes. Effective collaboration considers the financial, operational, and strategic perspectives across stakeholders.

 

Medicare Advantage (MA) is the leader of risk-based payment, far outpacing other lines of business. That said, MA is not yet the value-based care success story the industry hoped for. As enrollment increases, there will be increasing pressure to ensure better health outcomes at lower costs.

The future of commercial risk will influence the wide-scale adoption of VBC.

  • There are two paths forward for commercial risk: Path 1. Follow in the steps of the public sector; Path 2. Chart its own course.
  • Employers have the most bearing on which path the industry will follow, but not every employer is compatible with a VBC model.
  • Either way, commercial risk will decide the fate of value-based care.

Value-based care relies on accurate and organized data to measure quality of care, ultimately influencing risk.

  • While getting actionable, timely data is difficult, the ability to segment patients by level of risk is a fundamental capability for any organization to be successful under risk.
  •  If there is a place where an executive should over invest their resources, this is it.

Success under value-based payment requires the segmentation of patients to provide the appropriate levels of service based on risk. By evolving care models, employers are better positioned to fill gaps in care management and:


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