Shift Would Result in Better Patient Outcomes, Lower Costs
WASHINGTON, D.C., Oct. 11 – The health care industry and large employers should take seven action steps to accelerate the move to value-based payment models, Business Group on Health announced today.
Value-based care, in contrast to legacy fee-for-service payment models, aligns provider incentives with the best health goals for patients and has the potential to improve both care experience and outcomes, while mitigating costs for everyone involved.
“As a whole, these seven ‘calls to action’ would transform the health care industry,” said Ellen Kelsay, Business Group on Health president and CEO, who recently co-authored an opinion piece promoting effective value-based care for Modern Healthcare. “Providers, health plans, patients and employers all stand to benefit from the health care industry’s adoption of alternative payment models, which have already shown improved quality, affordability and patient experience.”
The seven steps, informed by members of the Business Group’s Executive Committee on Value Purchasing, include the following:
- Health plans should use their leverage across geographical markets to move away from fee-for-service payment models. Health plans, third-party administrators and other network contract administrators have massive purchasing power, when compared to that of any individual employer.
- Provider groups should embrace value-based delivery models or expect employers to increasingly partner with health care organizations that are innovating in value-based care. According to the Business Group’s 2023 Annual Large Employer Survey, adoption of virtual and on-site primary care is the fastest growing employer strategy for steering employees to valued-based advanced primary care.
- Consultants, brokers and other organizations that advise employers should move to assessments of value on total cost of care rather than fee-for-service network discounts. Employers need additional information, such as total cost of care and quality data, when deciding on vendor-partners and networks. Health plans, providers, consultants and other partners should make such information more available.
- Where value-based care has controlled costs and improved health outcomes, employers should reduce cost-sharing for members using those providers. The Business Group’s annual survey further details how employers have boosted access to several high-value sites of care and services, including Centers of Excellence, advanced primary care and mental health treatment.
- All stakeholders should be open to share data that would enable the effective implementation of value-based care. Sharing relevant data related to patient care and outcomes across health care stakeholders, even when organizations are collaborating, can be challenging. With new regulations requiring health care price data to be made public, there are opportunities for this information to help guide value-based care contracting and health care delivery strategy.
- Value-based care should incorporate an equity lens, which requires capturing demographic data and measuring disparate impact. While value-based care is not a panacea for addressing health inequities, it can empower providers to invest more in support services such as in-home visits by social workers and transportation assistance for patients, not often reimbursable in a fee-for-service model. In addition, relevant social determinants of health (SDOH) data would help in devising remedies to alleviate disparities.
- All parties should continue to incorporate virtual care into their value-based care strategies. Value-based reimbursements for virtual care mitigate concerns about payment for virtual visits followed by in-person visits, when the virtual visits did not resolve the patient’s issue. It shifts the discretion – and accountability – to the provider, who is in the best position to determine when a virtual visit, text message, email or phone call might be more appropriate than an in-person visit.
About Business Group on Health
Business Group on Health is the leading non-profit organization representing large employers’ perspectives on optimizing workforce strategy through innovative health, benefits and wellbeing solutions and on health policy issues. The Business Group keeps its membership informed of leading-edge thinking and action on health care cost and delivery, financing, affordability and experience with the health care system. Business Group members include 72 Fortune 100 companies as well as large public-sector employers, who collectively provide health and wellbeing programs for more than 60 million individuals in 200 countries. For more information, visit www.businessgrouphealth.org.