Employers join shift toward value-based care, highlight need for solutions

Monday, November 21st, 2016

The shift toward value-based healthcare is being championed by an increasing number of U.S. employers, according to data from risk management and employee benefit consulting firm Willis Towers Watson.

Survey results show 45 percent of employers are providing employee access to centers of excellence (COE) for healthcare, a jump from 37 percent in 2015. Meanwhile, an additional 32 percent of employers told Willis Towers Watson they plan to follow suit with COEs by 2018.

At the same time, only 17 percent of employers are encouraging COE use through reduced cost-sharing. However, 54 percent of employers said they may introduce such measures by 2018.

COEs were not the only sign of a move toward value-based healthcare. Twenty percent of employers now offer so-called high-performance networks, which are intended to include high-quality doctors at lower costs. This marks a rise from 11 percent in 2015. Thirty-nine percent of surveyed employers said they may incorporate high-performance networks over the next three years. Approximately half of the employers that currently offer access to high-performance networks reduce employee cost sharing for in-network services.

"16 percent of employers are considering contracting directly with organizations like ACOs."

Finally, 16 percent of employers responded that they're considering contracting directly with COEs, accountable care organizations (ACO) and patient-centered medical homes in order to access healthcare services at reduced prices. Currently only 8 percent of employers do this.

"As employers grapple with how to lower the cost of healthcare without lowering quality, they are increasingly looking to pay medical service providers for health outcomes instead of the services they provide," Trevis Parson, chief actuary of health and benefits at Willis Towers Watson, said in a press release. "Today, these strategies are more common in geographies where employers have large concentrations of employees or where cost-efficient providers are available and willing to engage in emerging reimbursement models. But this is just the start of a much larger transition - a move from a healthcare delivery system based on fees for services to a more patient-centric system based on fees for value or outcomes."

Value-based care leads to dip in practitioner profits
With the shift from volume to value underway, healthcare providers must contend with cost issues. Numerous providers have reported decreased profits in the face of a value-based healthcare model.

"This is an awkward and ironic in-between time," Jeff Hoffman, senior partner and healthcare strategist at Kurt Salmon's Health Care Group, told HealthLeaders Media. "The shift to value-based care tasks hospitals with reducing the number of procedures or inpatients for which they now receive payment and instead be pre-paid or receive a risk payment. That's not traditionally a recipe for profit growth."

In short, healthcare providers must do more than ever to maximize reimbursement while providing the highest level of care possible. Industry observers are urging organizations to invest in updated technology to help, with data analytics leading the charge.

"Healthcare IT systems have the biggest effect on care efficiency, quality outcome measurements."

A KPMG survey discovered healthcare IT systems were singled out as having the biggest potential effect on care efficiency and quality outcome measurements.

"Healthcare companies need to prepare for a dramatic shift in how they get paid," Dion Sheidy, advisory healthcare leader at KPMG, said in a press release. "They need to arm themselves with analytics to make the case that value and quality are being delivered in patient care and to compete more effectively in their respective markets."

However, there are more technology solutions available to healthcare providers beyond analytics. Intelligent Medical Objects' IMO 2.0 ETP allows organizations to proactively synchronize local dictionaries with clinical quality measure (CQM) inputs while making mobile documentation fast, easy and clinically accurate at the point of care.

The CQM dashboard included with IMO 2.0 ETP compares migrated terminology dictionaries and IMO's content against CQM standards. This not only assists with improving the quality of patient care through accurate reporting, it advises on whether organizations qualify for financial incentives.

Healthcare providers that wish to quickly assess whether they are on track to accurately determine patient populations for quality reporting can utilize the CQM dashboard while making use of clinical curated content that aids regulatory reporting compliance and helps ensure maximum reimbursement.

IMO clinical terminology is the most widely used in the industry - find out why.