Doctors Feel Excluded from Health Care Value Efforts
That’s the headline from a recent article about the Bain and Company survey of nearly 1,000 physicians, 100 health system finance officers and 100 health system procurement officers. The survey found:
- “Physicians want a hands-on role shaping a better model of healthcare” and
- “Bringing physicians into the decision-making process helps create greater momentum for change”
Bain’s research also showed decision-making for purchasing medical equipment has become collaborative, reversing a 10-year trend that shifted the authority from surgeons to procurement and finance officers. “More than 80 percent of practices said surgeons and procurement make decisions jointly, and surgeons are increasingly supportive of this arrangement. Surgeons who indicated high alignment with their practices’ mission are more likely to work in an environment using a partnership purchasing model.”
Involving Physicians Builds Trust and Technology Adoption, Critical Success Factors for Value-Based Care Success
In our experience at Geneia, we’ve observed the savviest health plans intuitively knew this about their providers, especially the ones with whom they have value-based contracts. That’s why these plans tapped these physicians to participate in the choice of a shared analytics and insights platform. Using our experiences with health plans and their network physicians, we created a list of best practices for effectively integrating value-based providers into the process of choosing an analytics tool.
I’ve spent much of this year talking and writing about payer provider convergence, and the critical role analytics can play in aligning health plans and physicians to work collaboratively to improve the cost and quality of care.
The creation of accountable care organizations (ACOs) and value-based care contracts are an important first step in achieving payer provider convergence. Health plans have moved aggressively towards performance-based contracts with physicians. Approximately 50 percent of reimbursement made by Aetna, Anthem and UnitedHealth are under value-based care models and Aetna has committed to growing it to 75-80 percent by 2020.
Early results indicate value-based care is working as intended:
- Anthem: 7.8 percent reduction in acute patient admissions, 9.6 percent improvement on pediatric preventive care, and monthly savings of $9.51 per participating patient
- UnitedHealthcare: 8 percent fewer emergency department visits and as many as 16 percent fewer hospital admissions. Breast cancer screenings are up 11.4 percent for commercial ACO members, and colorectal screenings are up 7.8 percent for Medicare ACO members.
- Capital BlueCross: Acute inpatient hospital admissions are 4.7-7.2 percent lower. Hospital readmissions are 8-14.8 percent lower. Emergency department visits are down more than 8 percent. Increase in 19 of 25 key HEDIS® measures.
It’s my belief that the next steps are the health plan helping its provider network to achieve success in value-based arrangements by providing an analytics platform that is shared and used by health plan staff and their value-based care physicians. To move beyond the ‘low hanging fruit’ of value-based care, providers need access to timely and comprehensive information about their patients and the ability to work much more collaboratively with health plan staff to manage the care of stratified populations.
In the words of Geneia’s head of solutions architecture, “Health plans and physicians need each other and each other’s patient data.” That’s precisely what a shared analytics platform makes possible.
It is even more powerful, building trust and greater technology adoption, if the providers who are going to use the platform are intimately involved in the selection of the tool. That’s why we created a list of best practices health plans can use to involve their value-based care providers.
Download our best practices for selecting a shared analytics platform.