With healthcare enrollment currently underway at most companies, looking into cost-effective ways to provide healthcare benefits in the future makes sense.
A recent article from the Business Group on Health offers some strategies for valued based purchasing. Noting that “ progress over the last 10 years to deploy effective value-based payment models has been uneven across the US,” it does acknowledge that there have been successful partnerships among employers, providers, health plans and other companies to advance value-based purchasing arrangements to pave the way for improvement.
Here are some ideas to move this strategy forward:
Provider groups must embrace value-based delivery models or expect employers to increasingly partner with health care organizations that are innovating in value-based care.
According to the Business Group’s 2023 Annual Large Employer Survey, adoption of virtual and on-site primary care are the fastest-growing employer strategies for steering employees to advanced primary care. These approaches afford employers more influence over how care is directed in primary care and how it is referred downstream for specialty services. Likewise, steering patients to high-performing Centers of Excellence is the fastest-growing delivery system approach for large employers in 2023 and beyond, benefiting providers taking on value-based reimbursement for quality outcomes.
Consultants, brokers and other organizations that advise employers must move to assessments of value on total cost of care rather than fee-for-service network discounts.
When employers are making decisions on which vendors to partner with and networks to select, they need to have total cost of care (TCOC), paired with quality data, to pick the best approach. Unfortunately, they often do not have this information available. Moving to measurements of total cost of care and incorporating quality into assessments is difficult, but a worthwhile endeavor. Health plans, providers, consultants and other partners should make data available to perform TCOC measurements and make decisions based on them.
Where value-based care is successfully controlling costs and improving health outcomes, employers should reduce cost sharing for members using those providers.
When providers are willing to take on financial risk and are succeeding in delivering high-quality care, employers should explore opportunities to reduce out-of-pocket costs for members receiving care from those providers. The Business Group’s annual survey details many ways in which employers are paying for travel and accommodation, as well as reducing cost sharing for and improving access to several high-value sites of care and services, including COEs, advanced primary care and mental health treatment.
Several payment and delivery reform partnerships have increased value for years, including:
- Cost reduction through bundled cancer care;
- Quality improvements and cost mitigation in General Motors’ ACO (accountable care organization) in Detroit; and
- Broad successes in physician-led ACOs through the Medicare Shared Savings Program.
Provider groups must embrace value-based delivery models or expect employers to increasingly partner with health care organizations that are innovating in value-based care.
According to the Business Group’s 2023 Annual Large Employer Survey, adoption of virtual and on-site primary care are the fastest growing employer strategies for steering employees to advanced primary care. These approaches afford employers more influence over how care is directed in primary care and how it is referred downstream for specialty services. Likewise, steering patients to high-performing Centers of Excellence (COEs) is the fastest growing delivery system approach for large employers in 2023 and beyond, benefiting providers taking on value-based reimbursement for quality outcomes.
Note: See further strategies.