Change is the theme of the moment in health care. There’s a general recognition that moving toward a health system that prioritizes prevention and quality of care is the right way to go, but almost no agreement on how exactly to get there. Nobody said leaving the world of fee-for-service would be easy, but I don’t think we envisioned that adopting fee-for-value would be this hard.
I frequently hear from leaders at health plans, health systems and physician organizations that adopting value-based care is what keeps them up at night. It is becoming more apparent that payers and providers need each other’s help to succeed, which means more than being willing to collaborate. They also need common platforms and tools.
This symbiotic relationship can be based on data and analytics. Health plans that are able to anticipate the needs of their populations, design the right interventions, and effectively predict and manage the total cost of care in the short and long term will be the high performers. Leveraging the data available to them to both inform their strategies and track their metrics will be critical. Health systems will need to view payers as partners so that providers have the data they need to drive visibility into the value they are delivering.
There are four building blocks that both health systems and health plans need to consider as they evaluate where they are on the road to embracing value-based care – and accessing the right health care intelligence can help you with each one:
- Infrastructure. It’s important to have the technology to enable real-time analytics.
- Interventions. Coordinating care and communications across multiple programs will help control total cost of care and keep members engaged.
- Field resources. These health care experts will help you more easily engage providers directly, and in turn, help them identify gaps in care and maximize incentive programs.
- Data acquisition. This goes beyond consuming and engaging data from electronic medical records and real-time lab connections to being able to view data clinically and from a predictive lens.
When payers and providers come together as strategic partners, it’s easier to maximize quality efforts and impact total cost of care. This is where sharing data and analytics that provide insight into quality, gaps in care and value delivered comes into play. You can read more about it here.
About the author:
Steve Griffiths, PhD, MS
Senior Vice President, Chief Operating Officer
Optum Enterprise Analytics
Steve Griffiths has more than 20 years’ experience in health analytics management, and currently heads up the Optum Enterprise Analytics organization. His main focus is driving growth and innovation through Optum products and services. Steve has a master’s degree in biostatistics from the University of Washington and a PhD in health services research, policy and administration from the University of Minnesota.