In recent years, payers have been wielding their reimbursement power to force a provider shift toward patient outcomes and quality — a recognition that the current transactional model of care is faltering, and that focusing on the procedures and not the results is not a sustainable business model.
According to Yele Aluko, MD, US Health Advisory Executive Director, Ernst & Young LLP, the priority should be delivering consumer value through systems efficiencies. “Effecting real change requires centering everything around truly delivering positive results for the patient,” Dr. Aluko said. “If the motive for change is reactive to the threat of reduced reimbursements or other pressures, a value-driven culture will not take root.”
A deliberate shift in strategy requires clearly and compellingly articulating the why, what and how to everyone involved in patient care. Though the path toward this culture shift is not easy, the potential upside is compelling: great patient outcomes, reasonable prices, and strong workforce satisfaction and talent retention.
Employers as power payers
Provider organizations and associations need to take the lead in ownership of the quality agenda, creating the “pull” toward value-driven care. Payers should continue to play a role in “pushing” change using reimbursement and other cost containment strategies to incentivize results. Although governments and insurance companies have a strong voice, large employers or employee groups are emerging as “power payers” in the industry.
Employers are already active in offering and encouraging healthy choices in the workplace through programs, such as on-site cafeterias, subsidized gym memberships and others, because they see the financial and productivity results. In fact, companies with exemplary safety, health and environmental programs have outperformed the S&P 500 by between 3% and 5% — and they are poised to do more. With built-in employee communication and education infrastructure, employers have the power to help change the way employees consider and think about health care costs and value.
Changing the patient conversation
It is a near global truth that people “buy” health care with no idea of its actual cost. Although many people are keenly aware of their monthly premiums and out-of-pocket fees, there are a few incentives to understand the true cost of care, differences in this cost between providers, or the cost or benefit value of any given procedure or test. In fact, many people don’t think of it in terms of a buying purchase at all.
The advent of big data and increasingly sophisticated analytics is having a profound impact on chronic disease and patient outcomes. Providers now have access to data shared within their networks of care, and in some cases, patient wearables, allowing for data sharing at a broader population level. New technologies are fueling progress in the analytics needed to consolidate these large sets of data into meaningful insights.
All these steps have the potential to give providers the information patients need to make better informed decisions about their health care and improve health organizations’ operational infrastructures. However, these insights will only become a reality if people are at the center of the equation, curating the data, managing the algorithms and finding ways to translate the insights into practical use.