This post is part of a series on Value-Based Care.
While healthcare reform dominates the news from Washington, employers are looking to forge their own solutions to underlying problems driving the high cost of healthcare in the US – and asking good questions about the role of value-based care in this effort going forward.
What is certain is that the fundamental expectation that employers and employees have of VBC – high quality care at a lower cost and an improved patient experience – is here to stay. Through evolving care delivery models and new technology, we are getting closer to meeting consumers’ expectation of high quality, accessible, and affordable care that is easy to navigate. But there is still a way to go.
The first and critical step on the journey to getting maximum value from new models of care is for employers to engage with hospitals and physicians. Reducing waste and improving outcomes will require a closer relationship among all stakeholders in the healthcare delivery value chain. To that end, employers and health systems have started to explore direct relationships that range from joint projects that focus on a specific clinical issue to Accountable Care Organizations (ACOs) and risk-sharing arrangements. The most important observation – perhaps lesson – has been that this is the first time health systems have had a real opportunity to understand employers’ needs and priorities. In many instances, health systems have invested millions of dollars in developing clinical services and solutions without first asking their largest customers – employer health plan sponsors – “what matters to you?” The fact that many large employers are self-insured – and what that means in terms of the employer’s responsibility and access to information – is sometimes news to providers. Similarly, the complexity and formality of hospital- physician relationships and the lack of readily available data are sometimes news to employers.
While value-based direct contracting appears daunting, taking that first step of engaging in provider conversations is more straightforward than you may realize. Sometimes the path to better outcomes is not complex at all and can start with a simple conversation about procedure rates, quality of care and patient satisfaction. In most cases, the data to inform these conversations is easily available. Employers are learning that initiating an informed, collaborative dialogue with providers can result in measurable improvement in the delivery of care to patients – without telling anyone how to practice medicine.
Value-based care begins with a mutual understanding of the stakeholders’ needs, priorities and limitations. As these new models of care evolve and spread, employers must realize that a productive, direct communication channel with healthcare providers – the kind you would have with any other important supplier – is a “have to have,” not a “nice to have.” Your employees’ health and your organization’s money are at stake.
To read more about employers’ role and actions in advancing VBC to their benefit, you can read the cover article in Workspan Magazine by my colleague, Molly Loftus.