Today’s transition from fee-for-service to value-based payment is undoubtedly healthcare’s most pressing financial challenge. The U.S. Department of Health and Human Services has set the goal of tying 50 percent of Medicare fee-for-service payments to quality or value through alternative payment models by 2018. Leading payers and providers in the private sector have pledged similar targets.
The pathway to the future is clear. Bundled payments, accountable care organizations, and a surge of other value-based organizations and business models will increasingly link financial returns to viable and vigilant population health management and coordinated care. In the sprint to the next horizon, healthcare organizations will need to adapt rapidly to the new realities – finding ways to avert avoidable hospitalizations, manage chronic care across clinically diverse populations, and continually engage patients in their health.
Extending beyond healthcare’s four walls
In the move from volume to value, a goal is to shift care from hospital and ambulatory care settings into the patient’s home – pushing care providers to scale far beyond their resource capacity. According to Dunnie Norman, senior vice president of sales at Vivify Health, a fast-growing international digital health company, the home is the least-expensive part of the healthcare continuum yet the slowest to be incorporated into the value equation.
“Patients spend 95% or more of their time outside the four walls of the health system,” Norman says. “Providers and payers need to embrace new ways to extend clinical reach and deliver care wherever their patients and members are.” He notes that with continual clinical data from the home care setting, the care coordination team can update care plans, manage medications, and make timely and more informed decisions for optimum, cost-effective patient care.
Enabling payer-provider collaboration
New realities call for fresh approaches. In the era of value-based care, payers and providers will need to collaborate in degrees unprecedented. As payer and provider organizations begin to work more closely together, they will need to invest in tools and technologies that they can jointly leverage to improve patient outcomes, reduce costs, and empower their members and patients.
“Remote care is a linchpin for achieving shared goals for population health management,” Norman says. “These technologies can help payers and providers close care gaps, improve quality, and together, minimize costs associated with the highest-risk patients.”
Key to any risk-sharing arrangement is engaging patients to become true partners in their care and well-being. Studies have shown that patients who receive ongoing education in disease management take more responsibility for their health and are less likely to be hospitalized. Remote care management programs can improve patient knowledge and accountability, facilitating early intervention and treatment plan adherence while reducing the risk of unplanned hospitalizations.
“In our view, remote care is a dialogue that takes place between the patient and care team through digital technologies,” Norman says. “Patients stay connected with – and committed to – their care pathway. This can make every difference in their health outcomes.”
Expanding the options
Not all remote monitoring systems are created equal, however. According to Norman, the most effective next generation of population health technology will:
- Give patients access to care wherever they are, at any time, using the device of their choice
- Interact virtually with patients at all levels of technology expertise, enabling them to transmit key data directly to care teams for robust analysis, rapid follow-up, and continual decision-making
- Include patients at any risk level, from high risk to rising risk, along with their family members and other at-home caregivers
- Integrate seamlessly with existing information technology systems and clinical workflows
- Provide care protocols that are disease specific and easily modifiable, facilitating patient compliance
- Offer video content and interactive videoconferencing to educate, encourage, and empower patients in their care
“The result is that patients are perpetually engaged and their behavioral change is supported,” Norman says. “It’s what we call the ‘last mile’ of population health.”
Envisioning the future
Alternative payment models are no longer the exception. They are readily becoming the rule. To adapt and excel, forward-thinking provider and payer organizations will need virtual care strategies that keep people healthy, use medical interventions appropriately, and prevent and manage chronic illnesses that consume a large part of the nation’s healthcare dollars. Organizations that take a proactive approach to the future of care – breaking new ground, incorporating population health technology into their overall growth strategies, and finding innovative ways to deliver value back to the health system – will be best positioned for long-term success.