posted by Marilyn Tavenner
on September 29, 2016
Earlier this month I was part of a panel discussion on the health system’s transition to value-based health care. What I hope attendees took away from the panel discussion is that value-based care is the right thing to do for the health care system and for patients. But as often is the case with doing the right thing, it won’t be an easy road.
The good news is we’re on the right road, and we’ve made a lot of progress. We’re continuing to move away from the outdated fee-for-service model that prioritizes volume and transactions. Instead, health plans are working to refocus the delivery system on rewarding quality outcomes rather than how many tests and procedures take place.
The work around quality and efficiency must begin with provider readiness to enter into value-based programs, such as bundled payment and medical homes. Over the past several decades of value-based reforms, we’ve learned there is no one-size-fits-all model – both in terms of provider risk and patient needs. So the provider and health plan need the flexibility to establish programs that can address the specific needs of providers and patients.
It’s also important to recognize the role health plans must play in providing actionable data and additional clinical support to make these types of payment models work to do what’s right for patients. Health plans can help providers know what’s happening with their patients as they move through the health care system.
Without provider support, value-based care models cannot achieve the triple aim of improving population health, enhancing that patient experience of care, and reducing costs. That’s why health plans provide regular feedback to physician practices and work together to align key quality metrics.
Some health plans are putting the focus on value through population-based models of care delivery that enable physicians to spend more time with patients who have complex health needs, while others are launching patient data initiatives to improve the health system’s ability to prevent, diagnose and treat disease.
Using health information technology, relying on evidence to identify the best treatment options, and having data to inform decision-making, we can work with providers to improve quality and improve efficiency, lower costs, and better coordinate care for patients.
Marilyn Tavenner is President and CEO of AHIP.