Agentes de seguros médicos

Fee-for-service models have experienced a gradual decline. According to a 2022 report, about 60% of health care payments from carriers were linked to value and quality while about 40% were tied to fee-for-service models.⁴

The factors that are helping pave the future for value-based care include:

• High health care costs
• Advancements in data analysis and technology
• Shifts in care preferences

As health care costs continue to rise, it’s no surprise that 70% of surveyed employers are focused on improving health care affordability over the next 3 to 5 years.⁵ Of those, more than one-third are considering value-based care strategies to meet their goals.⁵

A value-based care model is a fundamentally different way of reimbursing providers for care. Paying providers based on the quality of care delivered rather than the volume of services provided may result in better health outcomes, which can have a direct impact on the cost to employees and employers.

For example, employers whose employees choose providers that offer quality care at lower costs may see a favorable difference in their bottom line. Employees could see savings too, but it’s contingent on their provider selection.

“Employees have to go to the providers that are measuring up based on statistics, results and outcomes,” McDonnel says. “If they don’t, they and their employers won’t see the savings.”

To help, employers can provide education to their employees on how to make value-based care decisions.

Costs are one of the factors driving the shift from a fee-for-service model to a value-based care model; advancements in technology and data analysis are also responsible.

“We’re working to make it simpler for members to shop for services or providers through enhancements to our digital tools and optimizations that prioritize value-based care,” says McDonnel.

The ability to access, share and analyze data opens the door for value-based care models to become more effective and efficient. Advanced technologies that ingest mounds of data to reveal patterns and trends can empower providers and members to make more informed decisions that may lead to better health outcomes and lower costs.

It also requires making those insights easier for providers and members to access in real-time. That means finding ways to better connect and integrate data sources into the technology and digital tools providers are using — such as Point of Care Assist®, which brings real-time insights on a patient’s care needs into a provider’s electronic medical record (EMR). Or, in some cases, where applicable, it may mean developing new technology and tools.

“Take the example of patients seeing gastroenterologists for abdominal pain,” says Dr. Gerald Hautman, chief medical officer of National Accounts for UnitedHealthcare Employer & Individual. “Delving into the data, we can see that some providers are inefficient when compared to other providers — using more testing, changing medications and seeking more consultations to get to the correct treatment plan. Getting to the correct diagnosis faster is an important measure of quality and is better for our members.”

It’s no secret that consumer preferences are changing. The pandemic accelerated the rise of virtual health, and its capabilities continue to expand to meet consumer demand.⁶  Now, employees have an increased appetite to receive care in the convenience of their own homes, which is creating a window of opportunity for value-based care to thrive.

As such, UnitedHealthcare and Optum continue to make investments in home health care, viewing it as the next horizon of value-based care. Care capabilities that meet people where they are, especially for those who have difficulty leaving their home or find it challenging to engage with the system, demonstrate the type of quality care that defines value-based care.

Consider chronic or complex conditions. Through remote monitoring via wearables or other smart home technology, care teams may be able to better manage a patient’s condition without requiring them to come in for an appointment. This can decrease the frequency of appointments a patient may need but also the risk of them getting an infection at a hospital or provider’s office.

These solutions may be at the nexus of better outcomes, experiences and lower costs, which is what value-based care is all about.

With its potential to reduce costs and promote better health outcomes, value-based care can be a move in the right direction for many employers, employees and providers — but there’s work to be done to accelerate its adoption.

Payers like UnitedHealthcare can continue to enter value-based contracts with providers and then ensure they are accountable to deliver that level of care.

Employers can help accelerate this shift by choosing a carrier that demonstrates a commitment to value-based care through its work with providers. Going a step further, employers can provide education to their employees on how to make value-based care decisions, such as selecting a high-value provider or going to the site-of-care that is most appropriate for a given situation. Taking it further involves offering network solutions that encourage members to seek care from value-based providers. Examples of high quality network solutions include NexusACO®, Charter and Surest™.

As Sally Kim, director of health plan research at Advisory Board, notes: a shift to value-based care will only be received well if the experience feels seamless.

“Employers may be more on board with a narrow or tiered value-based care network if it’s paired with a better experience — say a patient advocate who really knows about their care from start to finish, because then that member won’t feel as if something has been taken from them,” Kim says.

McDonnel agrees with Kim, saying that alignment among all involved is key. “Ensuring alignment of incentives between payors, providers and patients is key to making value-based care work,” she says. “By leveraging high-performing product solutions, value-based incentive arrangements with network providers and providing tools that help members connect with providers delivering distinctive value, we are determined to help accelerate the market’s adoption of value-based care.”