How providers are making inroads in value-based care

The healthcare system is accelerating toward a value-based system, but several barriers remain in the way for providers, payers and stakeholders in between. In a recent survey, just 43 percent of physicians said some of their pay came from value-based care––a far cry from a truly revolutionized healthcare system that still largely relies on a fee-for-service model.

New innovations in technology and practical business solutions are helping healthcare companies find their place in the evolving care ecosystem.

Speaking at the 2018 Medical Group Management Association (MGMA) conference in Boston last week, executives from across the industry spoke about the current state of value-based care and the role of interoperability.


When it comes to interoperability, which can grease the wheels in a value-based system through data sharing and care coordination, healthcare has a long way to go, executives agreed.

“We’re on the first day,” said Marc Willard, president of Transcend Insights, a population health management technology and healthcare analytics company. “Healthcare feels like it’s 10 to 15 years behind other industries, like financial services. It’s a human barrier, not a technology barrier.”

New players from outside the space, such as Apple, are helping the space gain ground, however, according to Willard. For instance, Apple’s Health Records aggregates patient data into a user’s app and can work with EHRs. Patients of more than 500 hospitals and clinics are utilizing the feature, and Apple recently opened it up to developers and researchers to create more functions for patients to use health record data to manage health.

“Interoperability is in its infancy, but it’s really moving fast,” Willard said. “[You] see Apple coming in––it’s because they want to move it [forward].”

Similarly, consumers are demanding to view and access their records digitally. The interoperability and innovation will help push the broader healthcare system from paying for treating sickness to paying for managing overall health. In addition, consumers are getting more comfortable using technology to manage and improve their health through wearables.

“With all these new innovations coming out … in 10 years we’ll be talking about how we’re getting paid to stay healthy,” Willard said.

Value-based world

As payers shift incentives, it is essential for healthcare businesses to think about return on investment in a value-based world. The healthcare system still relies heavily on a fee-for-service model, and redesigning care practices around value-based care can be costly without strong incentives in place. Value-based care targets the “quadruple aim”: improving the patient experience of care, improving the health of populations, lowering overall healthcare costs, and achieving a coordinated, patient-centered care team that is engaged and satisfied in their work.

One of the first places to start is taking a hard look at the business operations and cleaning up operations that aren’t adding value.

“It boils down to time and money,” said Halee Fischer-Wright, MD, MMM, president and CEO of MGMA. “Start with the things in the business process and stop doing things that don’t add value. Second, [look at] where are the places you can make impacts.”

Making impacts to meet the aims of value-based care could be varied, from addressing social determinants of health to engaging in Medicare Advantage.

In addition, making “empowered partnerships where both sides benefit” is another crucial step in making progress toward value-based care, which relies on coordinated care efforts across providers.