If you manage your company's health plans, you've probably heard the term "value-based care" proposed as a solution to several challenges in the modern healthcare system, including poor patient outcomes, high-cost treatments, and low quality of care. But saying something has value and actually delivering value to the patient are two very different things. Determine what the shift to a value-based model means for your company, and learn more about how an app that motivates behavior change can make a difference.
Core Objectives of Value-Based Care Models
In the standard medical care model, practitioners are reimbursed based on the services provided. In the value-based care model, practitioners are reimbursed based on the results and quality of their patient care. In general, value-based care will focus on these objectives:
- Improving patient health outcomes through coordinated and preventive care
- Enhancing patient satisfaction by delivering personalized and timely services
- Reducing healthcare costs by eliminating unnecessary procedures and hospital readmissions
- Fostering provider accountability and continuous quality improvement
The acronym STEEEP is another way to reference the dimensions of value-based care. It stands for "safe, timely, effective, efficient, equitable, and patient-centered." This difference in thinking can shift treatment to more compassionate appointments, increased daily patient interaction, and a greater focus on holistic health.
Key Value-Based Care Models in Practice
Not all types of value-based care (VBC) models are created equal, and they come with varying degrees of difficulty in implementation. These are four of the most common types you may encounter:
- Accountable Care Organizations (ACOs): ACOs may be the most well-known type of value-based care. These collaborative provider groups share responsibility for cost savings and patient care. Typically, Medicare participants in ACO networks are paid based on cost reductions and improved care for patients. This means that when patients need care, ACOs can assist in coordinating and directing patients' next steps. This can save patients time, money, and stress.
- Bundled Payments: This model involves one payment made to a single provider, who will then assume responsibility for the patient's care. While this initiative can improve patient care and encourage efficiency in the short term, some policymakers, as well as providers involved, are hesitant to participate because of the possibility of fragmented care. This can occur when one provider takes full responsibility for a patient's outcome.
- Capitation: In a model with capitated payments, a provider receives a fixed, per-patient sum of money with the ultimate goal of promoting preventive care. Preventive medicine may include screenings for blood pressure, cholesterol, and other health indicators. It could also include yearly physicals, vaccinations, and health counseling. Over time, this model may lead to reduced health costs for patients or organizations and a greater focus on patient health for the provider.
- Value-Based Insurance Design (VBID): These insurance plans incentivize high-value care and discourage low-value services. Many insurance companies, both private and public, have implemented these programs.
The Critical Role of Interacting With Patients in VBC Success
Patient participation is vital to the success of value-based care. In general, patients who are more engaged with their providers and their treatment experience better outcomes. Engagement strategies can encompass telehealth, health literacy education, self-advocacy, and other measures of behavioral change.
Integrating Behavioral Strategies to Enhance Patient Interactions
Behavioral economics, with its roots in the study of empirical, observable human behavior, demonstrates that certain principles guide people in making decisions or avoiding them. When used in personalized interventions, such as part of a behavior coaching app, two behavioral economics principles — nudging and incentive structures — can help promote healthier behaviors:
- Nudges lead people to make certain decisions over others. For health, a nudge may involve stocking the fridge with healthy food or placing exercise equipment in a more easily accessible location. These frequent visual reminders and easy access prompt the individual to choose healthier behaviors rather than have them forced upon them.
- Incentive structures use penalties and rewards to change human behavior. This refers to incentives that motivate patients' behavior in the short- and long-term, as well as penalties imposed if they fail to meet their goals.
Addressing Challenges in Managing High-Cost, Chronic Populations
Providers often wonder how to improve getting new patients. As VBCs focus on patient outcomes rather than the financial value of patients or the quantity of people treated, one of these models may be a way forward.
Chronic, high-cost health conditions (such as heart disease, cancer, stroke, and diabetes) are often seen as a drain on the healthcare industry's finances and ability to care for patients. There are significant challenges in managing treatment for these populations. Patients experience setbacks when:
- There is a lack of clear understanding of their health condition and how to manage it
- Socioeconomic factors limit the patient's access to appointments or their ability to pay for treatment
- The patient becomes frustrated or discouraged with adhering to their treatment plan
It's possible to develop interventions for these populations with targeted strategies. Better care management — especially through a platform that allows the patient to learn and take control of their health — is often a good first step.
Strategies for Health Plans to Implement and Scale VBC Models
Transitioning to a value-based care model in healthcare is not always simple, but it is doable. It's vital that providers are engaged, willing, and educated about the benefits of VBC models. An organization may take steps like these to implement and scale VBC models:
- Determine which model aligns best with the organization's needs
- Provide education about what to expect from a VBC model for those involved
- Integrate a behavioral health platform for increased care plan adherence
Leveraging Digital Tools, Like Wellth, to Support Behavioral Interventions
Digital tools such as apps, habit trackers, and behavior coaching can increase patient engagement and ultimately boost health outcomes. A trusted daily care motivation platform doesn't just monitor patient progress on the provider's end — it gives patients real-time feedback and insights into their treatment. Providers can pinpoint weak spots in a patient's adherence to a treatment plan, and patients may find a renewed sense of enthusiasm in taking care of their health.
Are you ready to learn more about how digital tools like Wellth can provide real-time feedback and change patient behavior through daily interaction? Contact us today to discuss what Wellth implementation would look like in your organization.
