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Value Over Volume: 2 Looks At The Benefits Of Value-Based Care

by Darcy Lewis

February 5, 2018

Value-based care means high-quality care at a cost that’s affordable for both the patient and the U.S. health care system. With widespread support from health insurance providers, there’s been progress in moving from a system that makes payments based on the volume of care provided to one focused on the quality of care provided.

Two reports shed light on the state of value-based care, as well as outline actions various players can take to expand access and increase acceptance.

A look at the states

In 18 states, state employee health plans cover more than 10 percent of the commercial market, a significant fraction of the commercially insured population, according to researchers from the Margolis Center for Health Policy at Duke University.

With less employee turnover than the private sector, they can provide insights into what works in the value-based care arena. Plans have seen success with:

  • reference pricing
  • tailored prescription drugs and networks
  • bundled payments, and
  • accountable care organizations.

To implement these value-based reforms, state employee health plans work by themselves or in collaboration with other state agencies like Medicaid.

States and large commercial payers and purchasers can learn from the experiences of state employee health plans, the Duke researchers note, and look to them as partners in value-based initiatives.

The path to accountability

Accountable care organizations (ACOs) are groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care to a population of patients. ACOs now cover more than 32 million people in the United States through commercial and public contracts, and the federal government indicates it will continue to emphasize this approach, according to a JAMA article.

For the authors, a key factor in ACO success will be how health systems and insurance providers translate well-intentioned policies into meaningful actions clinicians can take.

  1. Financial Stability: Many systems have transferred financial risk from individual clinicians to the organization, while aligning clinicians’ salaries with ACO goals. Health systems and insurance providers should encourage primary care physicians and specialists to develop co-management strategies for mutual patients with complex conditions. They can also mine enterprise-wide data for care-related expenses that can be modified without harming quality, as well as clinicians who consistently lag in participating in ACO innovations. With these data in hand, health systems and insurance providers can share reports and expense information to further refine the ACO’s priorities and operations.
  2. Performance Measures: The numerous performance measures that accompany ACOs run the risk of redirecting clinician focus away from areas truly ripe for improvement. Outcome measures that depend on patient factors outside physicians’ control are a prime example. What helps: when systems and insurance providers integrate and simplify performance measures according to metrics that matter most to clinicians.
  3. Change Management Challenges: According to the authors, constant pressure to achieve change can make clinicians distrust the process. The authors recommend identifying “clinician champions” who can foster the interdisciplinary collaboration ACOs need to succeed. Health systems and insurance providers should also continue to invest in clinical decision support tools to alert clinicians to relevant patient referral programs at point of care.
  4. True Population Focus: Physicians are typically uncomfortable treating a subset of their patients differently based on insurance status, the JAMA authors note. Therefore, they encourage health systems and insurance providers to gradually make fewer distinctions between ACO and non-ACO patients. That may mean including all patients from the outset in programs like patient-reported outcome measurement and specialist e-consultations. Or health plans could offer other interventions with higher variable costs, like high-risk care management, to some non-ACO patients.

Taken together, both reports show the vibrancy and potential that value-based care brings to the table, as well as the creativity shown by the health insurance industry in attempting to solve the critical problem of uncontrolled health care spending.