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State Medicaid programs are increasingly interested in adopting various value-based payment (VBP) models with the aim of fostering efficiency and enhancing health outcomes within the system. Unlike Medicaid’s traditional fee-for-service payment model, which relies on the quantity of care delivered, value-based payment models incentivize providers to meet quality objectives and generate cost savings. Some models also incentivize improving the patient experience and addressing disparities in health equity.

In part 1 of our series on payer-provider collaboration, we talked about the challenge of data silos. In part 2, we’ll look at the challenge of provider abrasion and its cure: meaningful payer-provider collaboration based on shared and timely access to data.

Meet Chris, a 57-year-old individual battling stage 1 lung cancer in the Chicago metropolitan area. Amid his treatment, he finds himself dissatisfied with his current healthcare provider's level of attention and care. Chris is grappling with limited guidance regarding his illness, available treatment options, and the most suitable path forward. Moreover, he's often left to fend for himself when scheduling appointments, intensifying his stress and frustration.

The healthcare sector is in a state of continuous evolution. Technological advancements act as the primary impetus, propelling this change at a breakneck pace. Two such advancements, Artificial Intelligence (AI) and Machine Learning (ML), stand at the helm, laying the groundwork for an enhanced healthcare landscape by improving patient outcomes and optimizing the overall patient experience.

Cancer Statistics Society, a statistical division of the American Cancer Institute, estimated that there will be more than 1.9 million new cancer cases and more than 600,000 deaths due to cancer in the US, based on historical trends. That's a 31% mortality rate from new cases, and a horrific stat to ponder.

Healthcare is shifting to virtual, value-based care to address the needs of an increasingly aging and sicker population. There’s a need for more efficient population health and targeted individual intervention. This shift poses a challenge and an opportunity for pharmaceutical and medtech companies. The challenge is in figuring out how to meet the needs of organizations using value-based reimbursement models, while the opportunity is in taking the lead in building innovative solutions that help patients get the treatment they need faster and more efficiently.