Mike Boswood, President and CEO, Truven Health Analytics

Mike Boswood is President and CEO at Truven Health Analytics, part of the IBM Watson Health Business and General Manager of Value-Based Care at IBM Watson Health.

Time to accelerate the shift to value-based care

May 26, 2017 AT 3:07 PM

As the new presidential administration and Congress debate how best to address the evolution of U.S. healthcare, there is little doubt that the industry will continue to move away from paying for volume and focus more on value.

A snapshot: The state of provider readiness

A look at the results of the HealthLeaders Media 2017 Value-Based Readiness Survey reveals providers are still preparing for an anticipated shift in net patient revenue, expecting revenues from value-based payment models to more than double in three years, accounting for almost half (48%) of all net patient revenue.

According to the survey, respondents participating in value-based programs are still seeing uneven results in terms of lowering costs and improving quality. Fee-for-service programs with upside rewards and bundled payment programs have garnered the best results so far, with 22% and 20% of respondents, respectively, reporting both improved outcomes and reduced costs. But a significant percentage (up to 27%) of providers embarking on some sort of alternative payment model or incentive program are reporting that they are achieving quality improvements with no associated cost reductions. In addition, up to 18% of respondents say they are achieving neither improvements in quality nor cost.

To address these uneven results, 79% of providers surveyed are focused on developing financial competencies in value-based performance metrics, while 66% are developing collaborative relationships with payers and 27% are committed to sponsoring their own health plans; also, 50% are focusing on being able to model payer contracts.

On the care delivery side there is clear recognition that care coordination, clinical integration, broader access to care, care standardization, and patient self-management are key, with a majority of survey respondents (ranging from 79% to 66%) saying they are focused on competency in those areas. But only 3% surveyed say their existing care systems and processes are fully mature when it comes to supporting their care teams and practices in coordination, communication, and patient outreach efforts. Over half of those surveyed (54%) say they are either in the beginning stages of evolving their processes and systems (43%) or are still evaluating the requirements (11%).

Next steps: Advancing provider readiness

From our perspective, status quo information technologies are not going to be adequate to the challenges providers are facing. The combination of claims and clinical and socioeconomic data is needed for deeper insights into the overall population and to help enable holistic, person-centric care. Comprehensive data and the ability to derive actionable insights will potentially drive process improvement, improve personalized consumer engagement, and enable care teams to help individuals optimize their overall health by addressing clinical as well as psychosocial determinants.

The new model for care coordination and management is hard: It’s labor-intensive and expensive but it is also key to succeeding in value-based care, as evidenced by the survey and the nearly 80% of survey respondents that are committed to it. To make it work and to make it scalable, they will need information technology that provides a learning system that can improve over time. A learning system will help promulgate best practices across the whole care team, help connect the dots about a person’s health through all the myriad notes, documents, and data points about their health, and enable an organization to scale its care management efforts.

All of this requires a modular and cloud-based approach to solution design. It also requires not just vendors, but partners invested in organizations’ success to enable healthcare organizations to leverage what they need when they need it, and do it efficiently and cost effectively. We’re looking at a paradigm shift in how to think about healthcare transformation, as well as the information technology and relationships needed to support it. As the survey results show, the time to accelerate this shift is now.

This blog first appeared at Watson Health Perspectives