It’s Time to Double-Down on Value
“You either win or you learn.” That was Philadelphia Eagles’ quarterback Jalen Hurts’ observation after the team’s 38-35 loss to the Kansas City Chiefs in Super Bowl LVII.
That’s a great quote that works for football and team leadership in general. But in healthcare, and certainly at Innovaccer and across our legion of superhero customers—and, I would argue, at any innovative healthcare organization—winning and learning must go hand in hand.
Here’s what I mean by that. You probably saw the news that Innovaccer has been ranked the #1 data and analytics platform by KLAS for the second year in a row. In fact, Innovaccer clinched the top spot for the first two years that KLAS has covered this new category, after interviewing thousands of healthcare leaders nationwide.
That win was followed a few days later by Black Book naming Innovaccer the #1 platform for population health management, also for the second time. And that was followed by Innovaccer’s Enterprise VBCRM (value-based customer relationship management) earning a score of 96.1* in the 2023 Best in KLAS Report in the CRM category.
But these aren’t solely our wins. These are our customers’ wins. Three major customer-driven top rankings in a row were all driven by true, unfiltered stories from our customers about how they have been using our platform, our solutions, our advisory, and most importantly, how they have been learning to use advanced data and analytics technology to navigate the choppy waters in healthcare.
More than 65 visionary healthcare organizations across the industry—providers, payers, public health organizations, life sciences companies—now use our platform every day not only to outperform their peers in the race to deliver greater value to their population and the healthcare system overall, but also to learn while winning, and to share those learnings with us and other customers (such as at our recently concluded Xccelerate ‘23 customer conference).
That learning feedback loop is at the heart of our partnerships with customers, and sharpens the competitive edge for all. It’s one reason why our ACO customers consistently generate higher shared savings growth, earnings, and quality scores compared to peers. And also the reason why customers across both value-based and commercial lines of business have generated more than $1 billion in cumulative cost savings with Innovaccer.
On behalf of everyone at Innovaccer, I would like to express our sincere gratitude to all of our customers and partners. Your valuable insights and experiences have been instrumental in helping us enhance our platform, and we greatly appreciate your contributions.
Through your support and our shared learnings, the Innovaccer platform has consistently earned the highest ratings in some of the most significant healthcare industry rankings.
Your insights are also a key force behind our investment and product development strategy for 2023 and beyond. More on that later. So, thank you for your continued trust and collaboration.
Value is Both the Question and the Answer
The past year has been incredibly hard on healthcare organizations trying to get their charters in order, getting volumes back up, and managing risk. In 2021, hospital operating margins were doing okay. We went headlong into the pandemic, financial assistance flowed from Washington, and operating margins ended up mostly in the black.
Source: National Hospital Flash Report, January 2022
Despite that, however, the healthcare system itself was turned upside down. I remember speaking to many CEOs of our health system clients and they were saying (wondering, actually), "All of the service lines will come back, won't they? Everything will be fine in two or three years when the pandemic slows down, right?”
Wrong, unfortunately. It hasn't worked out that way. As the pandemic eased, the economy took a sudden turn for the worse. Inflation soared. Staffing shortages became critical, and staffing and operating expenses skyrocketed. In fact, 2022 was the worst financial year for hospitals and health systems since the start of the pandemic, and maybe one of the worst years ever. December was the only month where hospitals saw positive margins, after seeing their margins literally hammered throughout the rest of the year.
Source: National Hospital Flash Report, January 2023
We learned that the virtual networks we built during the pandemic were actually swaying patient volume away from our health systems. We also learned that organizations that moved to value-based care (i.e., risk-based models) before the pandemic were more financially and clinically resilient during the pandemic and its aftermath than those who relied on fee-for-service (FFS).
Duke University’s Margolis Center for Health Policy found that the payment models providers used had a significant impact on their financial stability and ability to adapt patient care to new circumstances. Healthcare organizations that assumed more risk had greater financial protection against FFS downturns during the pandemic, as their payments were not impacted by declines in service volume. Moreover, the flexibility of value-based payment models let healthcare providers rapidly pivot to establish effective care models during the public health emergency, regardless of whether the services or activities were reimbursed or not under the FFS system.
Source: Duke University Margolis Center for Health Policy
So, while these trends are alarming and these insights are informative to learn, they’re also presenting a great opportunity to win in 2023 and beyond. Health leaders are telling us they’re seeing 2023 as a tipping point—a time to embrace value-based care (VBC) for Medicare and chronic patients as an opportunity to strengthen their bottom line, and a time to do something we've talked about but done little to advance for the past 20 years: fully embrace the consumerism of healthcare to improve the patient experience and win back loyalty among commercial and healthy populations.
That means a different form of payment. A different form of engagement. Both are rooted in delivering value to the patient. How do we get our arms around that?
Value, it turns out, is the question and the answer. In 2023, it’s time to double-down on value.
A Pivotal Year to Pivot
What are you going to do over the next two years? Focus on Medicare, focus on where your value-based contracts are. But most important, focus on the experience throughout the continuum of care. It’s not a great experience. Services are fragmented. Consumers feel like the ball in a pinball machine being bounced around by the flippers. Clinicians don’t have all the data at their fingertips when they encounter a consumer.
The pandemic exposed all of this, and we can no longer wait to take action. There’s a massive opportunity to focus on delivering an extraordinary patient experience beyond portals and text messages that supports both your fee-for-service business and enhances, and even integrates with, your value-based business.
Value-based care for your Medicare contracts, value-based models for your risk-based contracts, and value-based care engagement for your patient experience are the three pillars to bring stronger (and more resilient) financial and operational performance to the fore in 2023; while improving access to and the quality of whole-person, connected, equitable care.
Source: McKinsey & Company
We're seeing this trend in investments occurring already. Value-based care investment quadrupled during the pandemic. McKinsey reports that private capital inflows to value-based care companies increased more than fourfold from 2019 to 2021, while new hospital construction—a proxy for investment in legacy-care delivery models—held flat.
This trend speaks volumes. The investments in fee-for-service can be proxied with a spend in the new hospital and clinical re-infrastructure. Capital inflows in value-based care assets rose from just 6% of capital investment in hospitals to nearly 30% over two years. It's not just a huge leap. It's the trajectory for the future, as payers, employers, and the government embrace these models. For example, CMS has established a goal to shift 100% of Medicare beneficiaries into an accountable-care relationship by 2030.
We're also seeing commercial contracts starting to take on downside risk, and that’s going to become a key piece, because employers are starting to ask for that. There’s been so-so results with managed Medicaid, and there’s now a big focus on looking at different primary care alternatives, and value-based approaches, to Medicaid across the board. It’s not just Medicare anymore.
And it is not just different lines of business. The landscape is changing in value-based care. We have providers who are mature in their value-based contracts trying to become payviders in order to get the total premium dollars back to them. And it’s also specialists. We’re starting to see specialty care providers saying, “We'll take the risk for nephrology care. We'll take the risk for cardiology care. We'll take a risk for a bundle for oncology care.” This is a brand new movement that’s gaining momentum quickly, working with primary care together, but focusing on a specific risk.
Going further, there are entirely new entities being formed solely to take on risk, backed by venture capitalists. You can also see this in the public markets for risk-bearing firms. Those that are profitable are doing really well in the stock market compared to all the indices. Value is taking off.
Then there’s the question of who else is going to enter the healthcare space? The big retailers are now capitalizing on what they're good at: the experience. Consumer experience, patient experience, client experience, member experience. We’re seeing Walmart, Walgreens, Amazon, Kroger's, and more—all the B2C folks that know how to engage a consumer (or member), make them loyal, keep them satisfied, and help them through the journey of their experience.
A Red Hot Race to Value
We’re all in a race to make sure we stay abreast and true to these healthcare market trends, and make sure that our investment thesis’ are geared towards remaining in step with and ahead of these trends. It’s clear that the time to pivot and double-down on value is now. At Innovaccer, our strategy for 2023 and the next few years is a reflection of that.
That means focusing on our core strengths: delivering, enhancing, and innovating the industry’s #1 platform for value-based care, population health, and what we call VBCRM—value-based customer relationship management. That means four things:
- Helping providers maximize their success with population health management and value-based care.
- Helping the provider groups who are trying to become payviders or the payers themselves.
- Helping health systems be more patient experience-centric, with an eye towards generating value as well as marketing success.
- Helping specialist groups to make sure that they can pick up episodic or disease specific value-based contracts really well.
So our technology and solutions investment thesis are completely tied to the market trends that we’re seeing. To that end, here’s a sneak peek at six breakthrough solutions that are among 20 new products, exciting updates and upgrades, and enhancements which we’ll be rolling out in 2023. Each and every one is aligned to these market trends to help you double-down on value, and are coming soon from Innovaccer in 2023.
- Sara
The industry’s first self-serve conversational AI tool makes unlocking valuable insights from healthcare data as easy as a text chat! Sara gives any healthcare professional actionable insights instantly, simply by asking questions in plain English. Just type in the question, and Sara will present the answer in less than a second. Just ask Sara!
- Health Equity Incorporate higher fidelity social vulnerability indices with consumer-level detail, and leverage analytics and dashboards to guide decision making. Easily connect patients with community services; track their social needs; coordinate quality care; and address the impact of social determinants on patient health, well-being, and quality of life.
- Readmission Predict Optimize discharge care planning and care management by using AI to predict the likelihood of readmissions at the time of discharge. Help care managers prioritize resources and devote more attention to at-risk patients to improve care outcomes and reduce costs.
- Risk AI Use AI, ML, and NLP to extract key features from unstructured documents, such as discharge summaries and progress notes, to identify potential conditions that might impact a person’s risk score.
- Network Optimizer Use Innovaccer-sourced multi-market all-payer claims data to identify opportunities to simulate optimal network configurations.
- Health 1:1 A powerful enterprise CRM solution built exclusively for healthcare in the value-based care era that brings together an array of innovative solutions—Marketing Campaign Manager, Experience Center, and Patient Journey—all designed to work together and help you find, guide, and keep patients for life.
Be sure to visit us at HIMSS23 booth #2216 to see and test drive these new solutions in person.
Winning and Learning: Not Mutually Exclusive
Going back to where I started, unlike football, we can partner together to simultaneously win and learn as we forge ahead in an increasingly complex and competitive healthcare marketplace.
As you read this, it’s safe to say that—today—there’s no better platform than Innovaccer for healthcare organizations that want to accelerate their success with value-based care, or otherwise improve key performance metrics associated with VBC—such as enhancing care quality, boosting financial and operational performance, or transforming the consumer experience.
No matter what payment models your organization is using or where it stands on the transition to value and taking on risk, no matter how lacking or mature your CRM system appears to be, the Innovaccer platform is fundamentally designed to help you accelerate your success today.
And tomorrow? The awards you have helped us earn—Best in KLAS, best PHM, highest-rated CRM—they don’t simply validate high customer satisfaction, loyalty, product quality, or product value. They validate what goes into achieving those things. A commitment to listening to our customers—what they want, what they need, what they fear. A commitment to understanding where healthcare is headed in the short-, mid-, and long-term. A commitment to remaining agile enough to pivot fast when a pivot is needed. Winning and learning with our legion of superhero customers.
We all know all too well that, in healthcare, what was a top priority yesterday can be overtaken overnight by a crucially important new business need or public health emergency. Nothing made that clearer than the emergence of the pandemic, which made the case for accelerating digital transformation better than any keynote address ever did.
Healthcare organizations that improved their digital maturity performed better across a range of competitive strategy, patient, and staff metrics, including outcomes, patient engagement, staff retention, revenue growth, profitability, innovation, and patient satisfaction. In fact, these hospitals are at least twice as likely to rate their performance as above their peers.
Last year, just as the pandemic crisis phase was finally fading, the economy took a drop. Financial survival is now the top priority (especially with Congress about to end the public health emergency, which will see Medicare payments cut by 20%). The need to pivot is now. It’s time to double-down on population health management and VBCRM.
We can’t rest on our laurels. Becoming #1 is just the start, and reflects our ability to ensure our customers are #1 with us by solving the challenges they have today. Staying #1 means we can never stop innovating with our customers; never stop working to make sure our platform is aligned to the current, emerging, and future needs of our customers, our partners, and the market; never stop working to ensure you can Xccelerate Your Success with Innovaccer.
* Why “Sara?” The name is derived from “Saraswati,” the goddess of knowledge who brings order out of chaos.
