Shift to Value-Based Care Means Changes for Healthcare Systems


Ten tips for successfully working with large employers in regards to value-based care.

The future of healthcare is moving toward a value-based future and away from fee-for-service healthcare. It is necessary that healthcare provider organizations develop new skills in order to better serve large employers.

According to an article published by Becker’s Hospital Review, there are 10 different drivers of success healthcare provider organizations need in order to develop high-value offerings for employers.

The first 4 drivers deal with being a high-value offering. Under this category, companies must consider all aspects of the potential offering and leave nothing underdeveloped, according to the analysis.

Companies need a product that has a well-articulated value. Employers must be presented with a plan that is clear in how they will achieve lower costs, a better experience, or improved healthcare.

The second driver of success is having a configured network to show the value of the proposition. Any partners must be screened for quality, cost, and capacity.

Developing contracts that include any attribution, exclusions, reimbursement structure, risk adjustment, and metrics for tracking success and formal performance guarantees are also quite important.

The contracts should not deviate from any existing contracts the organization may already have.

Next is making sure the health system has accurately priced services for a value- and risk-based plan. This may prove to be challenging because most have been primarily fee-for-service in the past, the researchers noted.

The next 3 drivers focused on ensuring health systems are clear in regards to what kind of market their plan is meant for.

Health systems must have a focused marketing strategy in order to be successful. They may need to ask themselves what kind of customer are they offering this plan to. Is it for employers, individuals, a Medicare or Medicaid plan, or is it something else?

Once the customer is evident, the next step is to gather basic information about the population. Whether that market is growing, shrinking, or changing will greatly affect different aspects of the plan.

Individual consumers must be understood as well. Their motivations, decisions, and health status are all key factors.

According to the article, it is important in a value-based strategy that individual consumers are engaged to become more proactive in improving their health.

Lastly, these organizations must come up with creative ways to make their offerings known to their target audience. Buying patterns of the audience are extremely important to be mindful of.

The last 3 drivers show that health systems must be able to deliver proposed value effectively. Large employers find it especially important that these potential partners are able to deliver to their employees.

Health systems need to make sure there is a straightforward organizational model, competent staff, supporting technology, and vigorous clinical care. This will improve cost and outcomes, according to the study.

Successful plans will also need current information from many different perspectives, such as patient, clinical, financial information, and more. Successful integration is needed in order to predict the impact of this offering, both to current and future customers.

The last driver for success is a sturdy financial structure for risk management. Both past and potential future risk must be assessed.

Cybersecurity and malpractice risks are essential to a value-based strategy, according to the article.

For new plans, the authors stated that this list can be used as a business plan to make sure all important aspects are covered. It can also be used as a way to identify improvements by companies who already have a system in practice.

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