The Future of Value-Based Care and Alternative Healthcare Payment Models

In recent years, the US healthcare system has faced challenges such as rising costs and declining quality. According to the Commonwealth Fund Report, the US has spent 17.8% of its GDP on healthcare yet the US is the only country, among OECD nations mentioned in the report, that doesn’t have universal health coverage, with the lowest life expectancy at birth and the highest rate of people with multiple chronic conditions and an obesity rate nearly twice the OECD average.

However, the emergence of new healthcare technologies has brought about a significant transformation in the industry. These technologies are paving the way for a shift towards value-based care and innovative payment models.

As healthcare costs continue to rise, there is a growing need for a payment model that focuses on improving patient outcomes and reducing costs for both patients and healthcare providers. This is where value-based care (VBC) and alternative payment models (APMs) come into play. In our earlier blogs, we traced the history of VBC, how VBC differs from FFS (fee-for-service) model, and the different payment models that tie patient outcomes to quality. In this blog post, we will delve into the future of value-based care and alternative healthcare payment models and how they are likely to shape the industry in the coming years.

The Three Core Pillars of Value-Based Care-Driven Healthcare

Value-based care is a healthcare model that emphasizes the quality and outcomes of healthcare services rather than the quantity. Its main goal is to improve patient outcomes and experiences while also controlling costs, making it a more sustainable and efficient approach to healthcare. In the coming future, VBC-driven healthcare will be characterized by three core pillars:

1. Consistent Use of Advanced Data Analytics and AI: With the increasing adoption rate of emerging technologies, senior healthcare executives must harness advanced data analytics and AI to gain deeper insights into patient populations. This will enable them to identify at-risk individuals and customize interventions based on their specific needs. Consequently, we can anticipate more effective preventive care and highly personalized treatment plans. The use of technology in healthcare will significantly enhance the future of value-based care. Electronic health records, telemedicine, and virtual care will enable healthcare providers to improve their care delivery, increase efficiency, and generate more data to drive better decision-making.
    
2. Holistic Provider-Payer and Provider-Provider Collaboration With Smart Workflows: As value-based care gains prominence, senior healthcare executives can expect a more comprehensive collaboration and integration among various healthcare providers. This approach will involve hospitals, primary care physicians, specialists, and community-based organizations. Patients will receive comprehensive, coordinated care that addresses their overall well-being as a result. Achieving value-based care goals will require enhanced collaboration between healthcare providers, payers, and government agencies. This will involve developing new payment models and aligning incentives among payers and providers.
    
3. Driving Patient-Centered Care: In future value-based care models, senior healthcare executives can expect an even stronger emphasis on patient-centered care. Patients will have greater control over their healthcare decisions, and innovative tools like telehealth, digital health solutions, and remote monitoring will empower patients to actively participate in their own care. As patients become more engaged in managing their healthcare, value-based care models will increasingly adopt a patient-centered approach. Healthcare providers must prioritize partnerships with patients to enhance healthcare outcomes. This trend will ultimately result in improved patient outcomes.

Will Value-Based Payment Models Evolve in the Future?

Senior healthcare executives will discover that value-based payment models are a critical part of the transition to value-based care. These models shift the payment focus from the conventional fee-for-service model to the quality, efficiency, and effectiveness of care-based payment. The future of value-based payment models will include the following developments:

Shift Towards Risk-Based Payment Models:

In the coming years, senior healthcare executives can anticipate a movement towards risk-based payment models, including capitation and bundled payments. These models will encourage healthcare providers to take on increased financial responsibility for patient outcomes, fostering innovation and cost control.

Evolving Pay-for-Performance Models:

Pay-for-performance models will continue to evolve, placing a greater emphasis on outcome-based incentives. Providers will receive rewards for meeting specific quality measures and will face penalties for underperformance. This will further drive improvements in healthcare quality.

Common Usage of Complex Care Episode-Based Payments:

Episode-based payments will become more prevalent, particularly for specific treatments or surgeries. This method consolidates all costs associated with a care episode, promoting efficiency and coordination among providers.

Where do Alternative Payment Models (APMs) fit in VBC-driven Healthcare?

As senior healthcare executives seek to enhance patient outcomes and reduce costs, alternative payment models will continue to gain popularity. APMs offer various reimbursement methods, promoting flexibility and innovation while highlighting the importance of quality. The future of APMs will encompass the following trends:

1. Direct Primary Care Models:
   Models such as direct primary care, where patients pay a monthly fee for unlimited access to primary care services, are increasingly favored. These models alleviate administrative burdens, improve care accessibility, and enhance the doctor-patient relationship.
    
2. Evolving Accountable Care Organizations (ACOs):
   ACOs are poised for further development, with increasing provider participation in these collaborative networks. The future of ACOs will feature expanded risk-sharing arrangements, further incentivizing providers to enhance patient outcomes and control costs.
    
3. Expanded Shared Savings Programs:
   Shared savings programs, such as the Medicare Shared Savings Program, will undergo expansion in the future. These programs reward providers for achieving cost savings while maintaining or improving care quality.

VBC reality will rely on Technology

As senior healthcare executives seek to navigate the realm of value-based care and alternative payment models, technology will play a crucial role. By adopting a managed SaaS service, providers will depend on a blend of technologies, including the cloud and preferred data technology of their partners. Several technological advancements will shape the healthcare landscape:

1. Continued Growth of Telehealth:
   Telehealth and remote monitoring technologies will experience sustained expansion, facilitating more efficient and cost-effective care delivery. Patients will gain access to virtual consultations, reducing the need for in-person visits and optimizing resource utilization across the industry.
    
2. Enhanced Health Information Exchange:
   Improved health information exchange will bolster seamless data sharing among healthcare providers. This will enhance care coordination and ensure that all providers have comprehensive access to a patient's medical history. The growth of information exchange will also be influenced by federal and state regulations.
    
3. Predictive Analytics:
   Predictive analytics will be utilized to identify high-risk patients, enabling proactive interventions. Healthcare providers can allocate resources more effectively, mitigating hospital readmissions and emergency room visits.

Value-driven approach in healthcare, led by value-based care models, prioritizes quality of care above quantity. As technology and data analytics advance, these models offer patients improved healthcare experiences and contribute to the long-term sustainability of the healthcare system. The ongoing and complex transformation of healthcare necessitates a shift toward value-based care and alternative payment models, which represent a promising step forward. Healthcare stakeholders should embrace these changes and persistently strive for an efficient, effective, and equitable healthcare system.