The pursuit of value-based care

What exactly is Value-based care? This question has been looming in the healthcare space for a long time, and there has been no single definition. In simple terms, it is the shift from quantity to quality regarding delivering health care. This means a conscious effort on the part of providers to avoid truckloads of tests, treatments and medicines and the care provided by hospitals, doctors and physicians will be measured based on its value and not its volume.

The healthcare industry is deeply rooted in the fee-for-service model, resulting in rising healthcare costs, clinical inefficiency, and duplication of services and discarding it in a snap is no easy task. The key- value-based reimbursement to address these issues and make it easier for people to get the care they need. Unfortunately, for a country that spends nearly 18% of its GDP on healthcare, less than half- 41% adoption rate of value-based care is unsettling.

The pursuit of value-based care

At the end of the day, all the services in healthcare are to drive better clinical outcomes and make patients healthy. Healthcare costs for patients and payers alike are constantly on the rise, and it’s important to assume a patient-centric approach. Therefore, providers have to tick off and choose a model applies best to their capabilities, market position, financial situation, and value-based goals to achieve better outcomes at lower costs.

For instance, consider a patient who recently had a stroke. The data-driven results prove that if aspirin is given to that patient within 15 minutes of the episode, then chances of another stroke are reduced by 75%! Now let us take a step back from here and think of this scenario, what if the health coach is able to notify the patient about their rising cholesterol levels prior to a possible episode and help them take precautions and avoid an acute episode.

Precautionary measures like these can only be taken, if we are backed by data. A Data-driven approach will not only help in this sphere but going forward it will streamline the care process.

Aiming for a data-driven healthcare

With the boon of digitization in healthcare, and especially with strong analytics, it is not only possible but fairly easy to achieve data-driven, quality health outcomes. Digital channels combined with strong predictive and prescriptive analytics play a key role in being the primary source of information, determining potential risks, communicating vital health information, and what the patient needs in order to look after his or her health.

Healthcare IT has been a buzzword, and rightly so. Having a data-driven healthcare, assisted by technology can close in on the following gaps:

• Data exchange: A timely exchange of information is important for population health management. Failure in data sharing and lack of access to timely care is one of the major roadblocks in the journey of value-based care.
• Interoperability: There are multiple datasets in healthcare, and they all hold valuable information. In order to ensure access to valuable information by all network providers, it’s important that information is readily available to them, beyond technological barriers.
• Rising costs: One of the biggest reasons why providers don’t opt for value-based care is that it’s fairly tough to realize profit without supporting components. Having a data-assisted program can help providers identify shortfalls and growth opportunities and realize every dollar.
• Risk identification: To serve patient population better, providers need to identify the needs of their patients and deploy effective, custom-made solutions for them. High-need, high-risk patients are only about 5% of the population, but account for a major share in healthcare spendings.
• Manage transformation: Value-based care and digitization are two inseparable terms. Even so, the evolution from fee-for--service to value-based care is not an easy one. The primary step in this transformation is to set benchmarks, plot a roadmap, and assess growth opportunities.

Barriers along the way

Now like many other fields, be it medical or otherwise, there are some challenges that still remain. For instance, several hospital networks are yet to achieve 100% interoperability. In other hospitals, an efficient health IT infrastructure is missing. It is crucial that hospitals ensure that they have shareable data on internal systems and automate end-to-end processes as much as possible.

Still, technology is secondary. The primary issue that needs to be tackled is getting providers on board. Physicians and caregivers do consider the improvements and benefits value-based care will be bringing along the way,  but delivering affordable and effective care to masses and reducing costs is a challenging task.

Road ahead

Hospitals should keep striving to achieve 100% end-to-end interoperability. They should work towards strengthening the overall data infrastructure. Healthcare providers must continually add new services to build value and familiarize patients with digital service provisions. This will work in favor of patients, providers, and payers. It is a win-win for all parties involved.

Around the world, seven countries in total have either adopted or formulated policies to adopt the value-based system of care. These are mostly rich countries with the exception of Turkey and Colombia, which are developing nations. Sweden and U.K. are the leading nations which have taken up value-based care. Lagging behind are countries like Germany, Hungary and this includes the United States of America.

Value-based care may not be the care that every American needs, but it is the care that every American deserves.

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