Xtelligent Healthcare’s recent Payer+Provider Virtual Summit was focused on strategies for industry leaders to collaborate and innovate to significantly advance healthcare in the United States. A familiar topic came up in several sessions: value-based care. In a panel discussion title, “Beyond a Payment Model: Value-Based Care Advances Access, Quality, Equity and Affordability,” leaders from Humana and CenterWell Senior Primary Care explored the impact the pandemic has had on value-based payment models and how those models can bridge significant gaps in care.

The Pandemic Amplified Unmet Patient Needs

The speakers all agreed that COVID-19 revealed serious limitations of fee-for-service payment models, especially considering the uncertainty the pandemic caused. Providers who were still focused on episodic and acute care needs were not prepared to pivot to virtual encounters and deliver holistic, comprehensive care. Providers who had already shifted to value-based care before the pandemic had a foundation in place to be resilient and adjust to a rapidly changing situation.

Value-Based Care Organizations Were Better Prepared for Uncertainty

Erica L. Savage-Jeter, a clinical leader at CenterWell – an organization focused on value-based care – described how her organization cares for seniors, a population that was extremely vulnerable at the start of the pandemic. She was not only concerned about preventing exposure and infection, but also about identifying potentially negative impacts of isolation including depression and food insecurity. CenterWell, however, had already built an integrated care team as part of their transition to value-based care including physicians, clinicians, care coaches, social workers, pharmacists, and behavioral health professionals so they were prepared to pivot to virtual care and address both acute and social needs.

At-risk value-based care models also could rely on a predictable revenue stream, so when patients all over the country stopped going to in-person medical appointments, those providers could still succeed. Providers who were participating in a value-based model, but were not at-risk, still benefited from existing partnerships with payers and could work with them to develop solutions to the problems created by the pandemic, highlighting the importance of payers and providers working together.

Value-based care providers were already delivering “whole person” care, focusing on promoting health, instead of treating illness. That resulted in a vastly distinct experience for them because they had already invested in an infrastructure that could serve different and unpredictable needs of patients. William Shrank, of Humana, was surprised when, even with full reimbursement for virtual care, fee-for-service providers did not significantly increase billing for virtual care. They did not have the tools in place, like telemedicine, and they also likely did not have the same insight regarding their patient’s needs outside of the clinic setting including transportation and health-related social needs.

The Importance of Focusing on Preventive Care, Not Episodic Care

Reimbursement must adjust to focus on payment for prevention instead of treatment. Delivering holistic care that avoids undesired outcomes requires time and resources, but it enables providers to focus on bridging gaps in care and keeping patients healthier.

After years of experimentation and missteps, value-based care finally has a foothold in healthcare, and it has the potential to significantly reduce health inequities. All the panelists pointed out how patients who receive care within a value-based arrangement have access to a different level of care than patients in a fee-for-service model and it’s time for that to change. 

Value-based models can promote equity, especially when there are incentives for collecting health-related social needs. As providers collect information related to social determinants of health, the panel also saw potential to begin to apply those learnings at a population level.

The Future of Value-Based Care

It’s not going to be easy or instant, but payers and providers can work together to minimize financial risk, help smooth the transition, and fund the investment that is necessary to move to value-based care. Healthcare needs to provide not only medical treatment, but also resources and support so all patients can live healthy and equitable lives; the pandemic revealed that value-based models are necessary to do that effectively.

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