This summer, I had the opportunity to talk with industry heavy-hitters about how the COVID-19 pandemic is impacting the shift to value-based care. To be sure, it was a lively discussion with:
- Mark Hagland, Editor-in-Chief, Healthcare Innovation
- Jamie Clarke, Chief Value Officer, Nemours Children’s Health System
- Melanie Matthews, CEO, Physicians of Southwest Washington
- Pamela Peele, PhD, Vice President, Chief Analytics Officer, UPMC Health Plan and UPMC Enterprises
The bottom line:
We’ll see more value-based payment models and capitation, because it’s recurring and reliable.
What I said during the event – and what my colleague, Geneia President and CEO Heather Lavoie, wrote in a recent blog, remains true –
Long-term, the COVID-19 pandemic is likely to incent more physicians to choose capitation, effectively advancing the shift to value-based care. In the short term, there are ways payers can help network physicians, including using analytics to identify members with the most care gaps connected to a chronic illness diagnosis and then outreaching to those prioritized members on behalf of their physician.
I also made the point that value-based care supports good healthcare. The tools, data and analytics we’ve put in place to support value-based care are precisely the same ones needed for good care.
An example is population health stratification and proactive outreach to patients for resumption of regular care following surge one of the pandemic. Hospitals and provider organizations need identification and stratification tools that help physicians and care teams answer important questions, including:
- Which patients do I prioritize?
- Why am I focusing on them?
- What do I need to do to outreach to them so it’s meaningful and contextual?
- How do I personalize outreach?
Payer-Provider Collaboration and Value-Based Care
There was a rich discussion about the impact payer-provider collaboration has on value-based care.
Physicians of Southwest Washington’s Matthews shared her perspective:
‘I think the relationship between providers and payers really relies on the foundations of any kind of successful business relationship—communication, transparency, guiding principles like what we’re trying to do together, the [collaborative] value proposition.
We have to focus on improving the health of the community, which requires:
- Realigning the way payers and providers interact so it becomes less adversarial and
- Aligning incentives and shared alignment for revenues, compensation and real data.’
Clarke of Nemours Children’s Health System underscored the importance of transparency, ‘If we’re in the this together, we need open books and open data.’
Dr. Peele of UPMC emphasized:
‘Payers and providers need to trust each other. If we don’t trust each, patients don’t trust us. Trust has to sit at the bottom of the three-legged stool among payers, providers and consumers. Data is key to trust.’
Hagland asked me whether we’ve created a kind of “trust but verify” situation between payers and providers, to which I replied:
‘Yes, it’s about relationships, and the data helps to instill a trusting relationship. Both parties – health plans and physicians – build trust by bringing their data to the table. It’s both payment and clinical data together. But like any relationship, you have to figure out how to talk to each other.’
'During the pandemic, we’re seeing health plans helping providers with financial resources, identification and stratification, care team outreach and more; they’re realizing in this emerging world that we all have to help each other. Relationships and technology are shining through during the COVID 19 pandemic.’
To view Geneia’s resources for physicians and payers navigating post-pandemic care, visit: