I read recently that the top priority for health plan executives is to improve member satisfaction. A HealthEdge survey conducted with 73 health plan executives revealed the following as top priorities:
- Improve member satisfaction
- Lower costs
- Improve provider relationships
Interestingly, the shift to value-based care came in dead last.
The same survey also asked about top challenges, to which respondents listed the following:
- Cost structures that stand in the way of innovation
- Lack of alignment among external stakeholders
- Need to update processes for business
Value-based care vs. value-based reimbursement
When I see a seeming de-emphasis on value-based care as a top priority for health plan executives, my first thought is: how do they think about and define value-based care? And, in the context of this and similar surveys, are they really talking about the less-patient-centric label value-based reimbursement or value-based payment?
If you define value-based care as delivering patient care that provides healthcare value, which has traditionally meant achieving the Triple Aim – improved outcomes, lower costs and greater patient satisfaction – then it’s difficult to see how this would not be the top priority of every health plan, health system and healthcare provider, as well as employers and patients themselves.
Value-based reimbursement, however, refers more specifically to payment models and the related infrastructure required between payers and providers to facilitate value-based payments. The models are based on pre-defined and measurable quality and cost outcomes, presumably the same outcomes to which we refer when we talk about value-based care.
But somehow the context in which value-based reimbursement is discussed and prioritized leaves the patient only tangentially linked, with conversations exclusively between payers and providers focusing primarily on financial targets, standardized quality metrics and cost-sharing models.
Last fall, HealthScape Advisors and the Health Plan Alliance surveyed health plan executives to “more deeply understand each organization’s journey toward value-based care and supporting fee-for-value payment models.” And the key findings centered around the challenge of transitioning to various payment and risk models, provider engagement and alignment, care transformation, and product design and member engagement.
In these examples, the patient is conspicuously absent, and maybe this is exactly the point. The current mindset and way of thinking about value-based care – or rather value-based reimbursement – doesn’t put patients in the center and is perhaps why health plan executives are seemingly deprioritizing a transition to value-based care and focusing instead on member satisfaction.
What drives health plan member satisfaction?
According to a J.D. Power and Associates report, “care coordination was the most important factor influencing member satisfaction, because it allows for easy access to doctors, but that coordination of care is lacking in most cases.” The report found that the highest-performing plans were those with integrated delivery systems, where patients had easy access to doctors and other healthcare providers. Only a quarter of the individuals surveyed felt they had received coordinated care from their health plan.
But truly coordinated and streamlined care requires greater alignment and collaboration among health plans and providers, which is what consumers feel is lacking and is the greatest barrier to achieving the Triple Aim. Commenting on the report, Valerie Monet, J.D. Power and Associates senior director of U.S. insurance operations, said:
“Amidst sweeping changes in healthcare delivery and payment models, our data is showing that the one thing consumers value most is clear-cut, easy access to doctors and other healthcare providers. This puts health insurers in a unique position because so much of their perceived value is reliant upon positive interactions with providers.”
Member satisfaction and perceived value depends upon greater alignment and collaboration between health plans and providers, achieving what we more recently refer to as payer-provider convergence.
Member satisfaction means putting patients in the center
What are the key ingredients needed for value-based care success?
- Collaboration among stakeholders to drive connectivity and interoperability
- Advanced analytics and access to holistic patient data through a shared technology platform
- Insights that guide and direct care teams to identify and stratify patient risk and prioritize outreach
- Better tools and systems to support care coordination
- Alignment among all participants in a patient’s care – health plans, physicians, care teams, community-based providers, employers – around shared goals and values
- Patients who are equally committed to successful outcomes and engaged in their care
- Ensuring patients remain at the center of the healthcare team.
For health plan executives, the path to higher member satisfaction and retention, as well as lower cost and improved provider relationships – the top three priorities identified in the HealthEdge survey – lies in value-based care success. They are not different or competing priorities, but part of the larger goal of improving payer and provider alignment and collaboration in support of personalized, patient-centered care.