The healthcare industry continues to undergo a massive transition to value-based care, prioritizing health outcomes and patient experience in a way that has never been seen before. This has opened the door for new care delivery models, payment models and technologies that put a greater emphasis on patient outcomes, engagement, adherence and empowerment.
What is value-based care?
First, let’s explore value-based care. Traditionally, the healthcare industry has been a fee-for-service model, meaning that providers get paid for each service they perform. Under a value-based model, providers would get paid based on how well they provide care; meaning the focus shifts away from volume and towards quality of care.
From a consumer perspective, it’s obvious that we should be focusing on how well the surgery was done, rather than how many surgeries can be done in one day. However, we all know that there is a lot more to consider from a business and bottom-line standpoint so that doors of healthcare providers continue to stay open and patients can be served. Business executives still need baselines and data in order to make a value-based system work.
Quality of care is tough to measure accurately. Should it be based on readmissions to the hospital? How about length of stay? Is it reasonable to have the same recovery metrics and expectations for a patient in relatively good health compared to someone who has four chronic conditions? What about providers who are the best in their field and take on the really tough cases? The performance results wouldn’t be a fair comparison. And how does the patient’s experience factor into quality of care? Needless to say, measuring quality is essential, but it’s complicated.
These issues have given rise to numerous alternative payment models, care delivery models, and vendor solutions. Value-based care and payments is one model that has been gaining much recognition. While it still has flaws, it’s hard to argue with the vision to elevate the importance of quality over quantity. Many healthcare organizations have embraced value-based models as the way forward for the industry.
Collaboration and consolidation through value-based care
Value-based care is one of the reasons we’re seeing increased partnership and consolidation in the healthcare industry. By having greater control over the longitudinal healthcare experience of the consumer, organizations can justify the upfront investment into quality. In other words, investing in aspects of population health (preventive care, analytics, outreach, etc.) and improving the patient experience will only pay off if you don’t solely make your money from sick people who enter the hospital.
Providers and payers are teaming up to create structure and contracts that are a win for everyone, individuals included. Providers will invest more in keeping people healthy, insurers will pay out less money to healthcare services, and then hopefully some of that savings will trickle into reducing the insurance premiums paid by the individual.
But where will the healthcare dollars go?
That is the big question. Less sick people mean less dollars floating around the healthcare industry… or does it? Healthcare experts are hopeful that value-based models will reduce the waste in healthcare such as unnecessary procedures, administrative paperwork, and transportation. These savings can be shifted towards wellness and well-being as our healthcare systems move from a sick-care model to providing more holistic care. The U.S. will still spend a substantial portion of GDP on healthcare, but we’ll shift it to the right areas. And some of the savings will get back to the consumers’ pockets, too!
With the healthcare consumer now at the center of the model, there is a greater focus on improving the experience. And a better experience is proven to also help with engagement, adherence, and outcomes. From providing price transparency to better communication with caregivers, there are tremendous opportunities to improve the healthcare consumer experience.
Furthermore, healthcare technology is booming with capital investment. From remote monitoring that allows patients to go home earlier to analytics and artificial intelligence that help identify people who are at risk for a health condition, healthcare is just getting started when it comes to innovation and consumer experience. There is still a lot of opportunity, and therefore investment, for this industry.
Marketing to the healthcare consumer
Due to this transition to value-based care and an increased focus on patient experience, it’s more important than ever for everyone in healthcare to understand the basics of healthcare marketing and how they can be used to create a more patient-centric approach. As mentioned above, an engaged healthcare consumer can have impressive results on outcomes.
Whether we are speaking to the patient directly, or creating new processes and services via payers, providers and vendors, it will be essential to empower the patient to make smarter healthcare decisions throughout their health journey.
As the shift towards value-based care and payments models continues, it is critical that organizations focus on quality metrics and adopt a patient-centered approach. Improving quality and experience, while maintaining or reducing costs, will be the key to success in the next era of healthcare.
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The National Association of Latino Healthcare Executives (NALHE) and Dignity Health Global Education (DHGE) are aligned in their mission to increase access to high-quality education and equity in healthcare