When payers and providers collaborate on patient care, combined with data integration and screening for social determinants of health (SDoH) — socioeconomic factors that affect healthcare — they can achieve a higher level of value-based outcomes at a lower cost.
An important aspect of effective risk-based payment models is interoperability, giving providers and payers access to data that highlights gaps in care and SDoH specific to each patient. Collectively, this data gives physicians the opportunity to address the whole patient – not simply a specific disease or condition.
Determinants of health may be biological, behavioral, sociocultural, economic and ecological and can be divided into four categories: nutrition, lifestyle, environment and genetics. When any one of these categories is vulnerable, a support system is needed.
According to the 2019 Value-Based Care Survey results, 72% of healthcare executives are ready for a risk-based alternative payment model and agree that incentivizing or rewarding members for health behaviors in the patient health population benefits the patients and rewards the healthcare system.
The Value of Sharing Patient Information
Sharing information between care facilities allows multiple doctors and care facilities to work together for the greater benefit of the patient. As a result, providers are better able to identify the most urgent issues that must be addressed for optimal care, improved outcomes and enhanced patient experience.
For example, many Medicare Advantage (MA) plans cover the SilverSneakers program, which helps individuals who are 65 years or older stay fit by providing access to gym memberships, weight training, aerobics and group exercise classes.
According to one study, SilverSneakers participants report significantly better physical and emotional health and less impairment in daily activities relative to a matched comparison group. Additionally, three-year longitudinal analyses revealed more favorable trends among SilverSneakers participants with respect to nearly all measures of health and impairment, suggesting that the program may help to slow or reverse natural trajectories toward declining health and functioning among seniors.
Florida Blue, Humana, and Optima Health have been using MA to progress their value-based care initiatives. A primary factor in MA plans’ role in healthcare is maintaining community for patients, relieving isolation and loneliness. A plan’s power to motivate value-based care relies on its connections with communities.
MA plans are uniquely able to support keeping people in their homes and communities, playing a key role in making healthcare simpler at a time when people are at their most vulnerable. These community relationships are often best used to address SDoH, which have a larger impact on member outcomes than purely clinical care. As part of this effort, for example, Florida Blue is working with a transportation service to get its members to their doctor’s visits because a lack of transportation is a key barrier to care for many people.
Payers and providers are shifting focus from fee-for-service to risk-adjusted value-based services, with the shared understanding that it takes an unprecedented amount of interoperability and analytics to support this model. Adopting technology solutions, like Evoke360, is critical to the success of value-based care.
Evoke360 is a clinical, operational and social determinant data platform built for true data transparency. Designed and developed from a provider and patient-centric perspective, Evoke360 changes the way information is shared, programs are implemented, and care delivered to improve quality, reduce administrative burden, enable value-based care and enhance financial performance and communication.
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