Escalating costs in healthcare have made a new path imminent: care provision cannot proceed in this manner for the remainder of our journey. It’s time to rethink our current value-based care (VBC) roadmap, call in a navigation app for rerouting, or even pick up a hitchhiker (kidding).
No matter your role in healthcare, the term value-based care is a familiar yet confusing one. It’s a concept that means different things to different participants. Key stakeholders want to know “What’s in it for me?”, “How much do I have to gain?” and “How and where do I cut my losses?”
Electronic medical record (EMR) vendors, for instance, consider the concept of VBC from the perspective of data collection, reporting, and ultimately reimbursement of providers who use the technology. Vendors must look to the government and payers on what’s deemed to add “value” and then design the EMR to help providers track and document these demonstrable values.
When considering VBC, payers emphasize that care episodes be productive: they don’t want patients engaging in clinical visits or tests that are duplicative or don’t directly lead to favorable outcomes. Payers have an interest in minimizing treatment expenses, which can often put clinicians in a situation where they have to eliminate what payers consider redundant or unnecessary, when diagnosing and treating their patients.
Patients in the midst of today’s shifting VBC model are shouldering an increasingly greater share of costs and often have to negotiate care terms, especially when insurers deny payment. Patients have a clear, vested interest in deciding what really adds value to their health, but that specific decision is typically not theirs to make.
While vague in its definition, VBC always comes back to the concrete question of money: who’s going to get more, who’s going to lose some, and who decides how it all shakes out. If the system as a whole works smarter, can everyone benefit in a tangible way? Can the VBC path take us on the road trip we’ve all dreamed of: an experience where health outcomes improve in tandem with overall costs being reduced? The answer lies in the reality that success of a VBC paradigm starts and ends with patient decision-making. It is the patient choices that will ultimately drive healthcare’s direction and set the overall tone for wellness in our country.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Taking a proactive stand in healthcare
Getting more value out of healthcare delivery is a complex pursuit. Nitpicking over the cost of an exam or the coverage on a given procedure is a shortsighted methodology. In the quest for a smarter, better healthcare system, we need to take a proactive look at the societal evolution of chronic conditions. Behavioral choices often result in an increased incidence of chronic disease, which is extremely costly to the system. Everyone agrees that proactive measures should be taken to prevent disease manifestation and development—especially heart disease, stroke and diabetes—as well as to improve chronic care management. Yet, there are few tangible financial incentives for providers to do so. Even in the VBC environment, providers are only reimbursed for managing patients from one visit to the next. For incentive programs that do exist, the cost of documentation to prove such active management is so burdensome as to make it not worth the incentives. Instead, the goal should be finding ways to keep patients healthy or help manage their conditions, which would truly reduce costs and provide value.
For true progress in VBC, all stakeholders—from the government to physicians to payers—need to back goal-setting in this area as well as incentivize the right achievements.
Empowering patients to take the driver’s seat
In managing patient care, especially in the case of chronic conditions, providers and payers need to adopt technologies that will allow them to connect regularly with patients to demonstrate a vested interest in their choices and treatment outcomes. This begins with making a complete health record available to patients. This access must be secure and easily attainable to enable patients to gather their personal health information and use it for their own benefit: to schedule appointments, follow up with specialists, read laboratory test results and track their own progress. By automating and simplifying this process for patients, there’s more value and efficiency in driving care.
Let’s look at the example of a diabetic patient whose physician advises he track glucose values daily. The method in place may be a notebook or excel file which the patient shares at a future appointment. But if the provider makes an electronic form easily accessible, the physician can see the patient’s inputted values and easily analyze and trend that data for future forecasting. Alerts or triggers can indicate when the doctor should reach out to the patient with suggestions or reminders about the treatment plan, or to come in for a clinical visit sooner than planned. Then there’s a real-time feedback loop in the data aggregation process that enables all participants to feel engaged and accountable.
Some patient portals make this possible now, but taking it a step further, a successful VBC model would enable engagement with patients in a social-media-like platform. If a patient is obese and has COPD, for example, providers could directly reach him or her through an application with patient digestible data and research-based articles about his conditions and the steps required to lead a healthier life. The patient would receive regular reminders about exercise, diet and smoking cessation strategies. With encouragement for improved lifestyle choices, the patient becomes more self-aware and health-aware, the driving factors for successful engagement. As providers take control of educating and communicating with patients, they then hand it over to the patient for better decisions and stronger outcomes.
Tying it all together
Just as successful travelers avoid traffic jams and select the best routes with the help of both technology and their travel buddies, so must healthcare consumers have the right tools to succeed in caring for their health: data, knowledge, support, and frequent communication with providers or care managers.
All of these discrete pieces of information and technology exist, from tracking tools to appointment management to patient-facing educational information, and, of course, the EMR. It is time to use these technologies to communicate information that’s most relevant to patients’ health, enabling prevention through proactivity. With tools for a thoroughly planned and well-connected journey, the patient can finally put the pedal to the metal for improved health.
