Value-based Care: For Employers, It’s a Prescription for the Future

by Ed Clarke, M.D.

Delivering best-in-class products at a fair price and with stellar customer service is at the core of every company’s mission.

Now, the healthcare industry is embracing these principles with a progressive model of care that rewards physicians and hospital systems for the quality of their clinical outcomes instead of the number of services they provide. Insiders call it a transition “from volume to value.”

Value-based care is designed with patients in mind. The idea is to keep them healthy and help those with chronic or acute conditions find the best, most cost-effective treatments and avoid escalation to more costly interventions.

For companies, the result is a healthier workforce that stands to be more productive on the job.

The shift from volume- to value-based care is not new (the healthcare industry was heading in this direction long before the passage of the Affordable Care Act), though it is growing in popularity among both public- and private-sector employers.

One reason is, value-based agreements enable employers to customize corporate health plans based on the needs of their workforce. It makes sense because employees who work in an industrial setting have different needs from those in a sedentary office environment. The health status of a company’s workforce also can dictate the type and range of services in a value-based plan. So can an employer’s commitment to wellness in the workplace and the level of employees’ engagement in their health.

Some considerations: Does the company have an on-site gym or offer healthy menu items in its cafeteria? Are workers faithful about getting annual health screenings? Does the work environment make them prone to certain conditions like high stress or low-back pain? And do they exercise regularly or need help from a health coach?

Healthcare coverage arrangements that address the individual needs of employees is just part of what makes value-based care a promising model now and well into the future.

Beyond the actual care — whether it is preventive or for a chronic or acute condition — is the support to help clinicians succeed in a changing healthcare environment. Value-based care aligns the goals and interests of patients, providers and payers, and then puts in place components — from clinical teams that help physician offices coordinate care to hospital “navigators” who guide patients through the clinical, administrative and financial process before, during and after a health procedure, to health coaches who help patients with chronic conditions to get all the care and support they need.

Technology also plays a critical role in delivering value-based care by connecting patients to a vast network of clinicians across the health system, while breaking down data walls among providers, so they can share information and glean insights on the health of patients and the larger community.

But a successful value-based care model is not complete without rigorous clinician performance documentation and patient satisfaction reporting systems. This includes constant, transparent communication, along with a scorecard to help clinicians track their progress in achieving the “triple aim” of improving patient care and satisfaction while managing overall costs.

Value-based care models continue to evolve. Still, one point is clear: For employers, value-based care is a significant step forward in contributing to not only a healthy and productive workforce, but the safety and quality of life in greater Phoenix as well.

Ed Clarke, M.D. is chief medical officer of Arizona Care Network, a physician-led and -governed, clinically integrated network with 5,000 clinicians who provide a broad range of clinical and care coordination services to more than 170,000 patients through value-based agreements.

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