MedCity Influencers, Consumer / Employer

How Corporate Healthcare is Leading on Value-Based Care

Value-based care depends on keeping a total population of patients healthier and less in need of higher-cost services. To do so, organizations must be able to predict costs in advance, better understand patient risks, and manage the cost of services. Corporate healthcare is set up to do just that.

The business of healthcare has evolved significantly over the last two decades as stakeholders, from providers to policymakers, have looked for ways to manage costs while improving patient outcomes and achieving health equity. More and more independent practices have been purchased by health systems, offering economies of scale while promoting provider accountability for the delivery of high-quality, equitable, and more affordable healthcare services.

Now a new player–corporate healthcare–has entered the market. In 2021, 52 percent of physicians were employed by corporate healthcare companies instead of traditional medical groups, hospitals, and health systems. Amazon, Aetna CVS, and Walmart have acquired practices and hired new physicians, and they are marketing telehealth and personal visits at their clinic locations. They are doing so while participating in value-based care, the dominant payment reform movement.

Indeed, more change is coming. And after decades of rising costs in U.S. healthcare, corporate healthcare is going to help shape the future.

Corporate healthcare brings new benefits to physicians and consumers.

Value-based care depends on keeping a total population of patients healthier and less in need of higher cost services. To do so, organizations must be able to predict costs in advance, better understand patient risks, and manage the cost of services.

Corporate healthcare is set up to do just that. They are equipping physicians with capabilities for value-based care that weren’t available in traditional settings. First, physicians are getting key tools: data, analytics, systems, and support they need to provide effective care. Second, most corporate healthcare companies are emphasizing clinical decision-making autonomy while recruiting practices and physicians—within an environment in which care and value (or problems) are continually measured by data.

Corporate healthcare is likewise bringing benefits to consumers. Consumers have long been frustrated by traditional healthcare’s lack of respect for convenience of scheduling, by the inability to access medical records, and by high costs. By contrast, corporate healthcare’s access to online appointments, telehealth, and quick services is very appealing. For the first time, we’re seeing an emphasis on consumer choice and convenience as strategic priorities.

As corporate healthcare grows, traditional healthcare must accelerate change.

These corporate investments in physicians and consumers are well-timed. The value-based care model aligns with corporate healthcare growth. Newer value-based care payment models deliver per-patient monthly payments up front, and corporate healthcare companies are applying to participate in new accountable care organizations’ payment models. They are also developing their own or participating in insurers’ Medicare Advantage plans, an alternative value-based care model sanctioned by Medicare to enroll patients. Fifty-one percent of Medicare beneficiaries, which includes adults over 65 and individuals with disabilities, are enrolled in these private plans, all with predetermined monthly per-patient payments.

The movement of physicians away from traditional providers has significantly accelerated value-based care. As patient-driven revenues move with physicians into corporate healthcare, however, this leaves traditional health systems more fragile. Traditional systems will face new challenges covering complex patient care needs, especially those involving hospitalizations and high-intensity specialty services.

There are also legitimate questions about whether corporate healthcare will share value-based goals, such as health equity and improving outcomes, when a return on investments—profits—are essential. Will they be willing to treat the poorest and most-complicated patients?

Indeed, there are many facets to traditional healthcare that could be put at risk as the revenue structures shift. These range from physician training and internships to research to improvements in medical technology. Moreover, what happens to hospital inpatient and outpatient services, trauma centers, and diagnostic facilities when the revenue base for traditional healthcare shrinks?

Driving value-based care while doing no harm.

Despite these challenges, value-based care has been transformative. For example, traditional health systems are slowly moving toward financial risk. And Medicare administrators, forgiving of providers’ fears of value-based payment models, have provided relief. But more needs to be done to ensure that the healthcare system remains sustainable.

For traditional healthcare systems to survive, they will need to adopt similar systems and tools as corporate healthcare. At the same time, both corporate and traditional healthcare must recognize that, while being competitive, they must also seek to innovate and protect the healthcare system.

As part of this balancing act, traditional providers must be encouraged along the path to risk without dramatic changes in policies or models. It will also be important to facilitate the adoption of data and technology through investments and incentives. And, finally, all payment models must support an increase in the supply of primary care and essential specialty physicians to ensure that everyone who needs health care, from all walks of life, can access critical services.

Photo: doyata, Getty Images

Theresa (Terry) Hush is a health care strategist and change expert with experience across the health care spectrum. Terry’s broad range of health care experience includes executive positions in public, non-profit and private sectors, from both payer and provider sides of the business, peppered with health care public policy and regulation experience. She is co-founder and CEO of Roji Health Intelligence, formed in 2002 to help providers implement Value-Based Care with technology and data-guided services. An expert at creating consensus for desired change through education and collaboration, Terry helps organizations to move toward cost and outcome accountability to achieve growth.

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