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How payers, employers can expedite healthcare’s transition to value-based care – MedCity News

How payers, employers can expedite healthcare’s transition to value-based care – MedCity News


The Holy Grail in healthcare today is a patient-centered, value-based care system. However, achieving this is not easy and some healthcare organizations are better suited than others to achieve this difficult transition away from fee-for-service, according to the Business Group on Health.

The organization, which is a nonprofit that advocates for employers, believes that payers may be in the better position than employers to make the leap to value-based care, said Dylan Landers-Nelson, director of Business Group on Health. It released a call to action Tuesday with seven steps all healthcare stakeholders, including insurers and employers, can take to move to the new model.

“It’s difficult for a provider group to take on risk-based contracts with a single employer, because you need a patient population that’s big enough that they’re not going to be financially penalized for just that risk pool,” he said. “And health plans, because of the significant influence they have in a given market, we’re saying [they] should leverage the fact that they have a significant presence in a market and take all the members, regardless of how they’re funded, and align their value-based purchasing strategy.”

In other words, Landers-Nelson wants payers to review how they negotiate with providers and add them to their network irrespective of how patients are covered by insurance.

“Right now, it’s not always done in such a way that they’re taking that entire pool of plan members and aligning the contracting that they do with providers based on the full weight of all of the plan members that they cover,” he said. “So it’s a different negotiating or contracting process for different types of funded insurance.”

If they were to align their strategies across their book of business, they could have a better chance of negotiating value-based arrangements with provider groups, Landers-Nelson said.

“Payers could be taking a larger portion of their plan member population and going to providers and saying, ‘We’re not only going to contract with you in value-based purchasing for our commercially insured population. We’re going to do it across the lines of business that we have,’” Landers-Nelson said. “And that gives them a better negotiating position to start requiring providers who want to be in-network to take on financial accountability for the outcomes and quality of care and patient experience.”

That doesn’t mean there aren’t things employers can do to expedite the movement to value-based care, however. Employers should include incentives that encourage employees to receive care from providers participating in value-based models, Landers-Nelson said. This could include reducing or eliminating out-of-pocket cost sharing for those provider groups, or reducing premiums for choosing a plan that’s built around a value-based model.

“Employers should be looking at ways they can … encourage their employees and their families to go to those providers that are participating in value-based arrangements,” he said.

Still, the transition to value-based care will present challenges for both payers and employers, Landers-Nelson said. Especially because it requires a significant culture shift — it can be difficult to move to value-based models after investing big bucks on fee-for-service for so long.

“It’s just hard to move very large organizations toward a fundamentally different model,” he said.

For employers specifically, it can also be difficult to encourage employees to go to providers they’re not used to, Landers-Nelson added.

But while moving to value-based care isn’t easy, there are major benefits, he said. Costs are mitigated and patients ultimately receive better quality care. And the movement is going to need action from all stakeholders in healthcare, Landers-Nelson stated.

“We do believe in multi-stakeholder collaboration and partnering with health plans and provider groups and other facilitators with these models to improve the care that employees and their families get,” he said.

Photo: atibodyphoto, Getty Images