The health care industry has been talking and hearing about value-based care (VBC) for several years, but the time for talk is quickly shifting to a call for action.
The U.S. currently spends $3.3 trillion, or 18 percent of our gross domestic product, on health care1–more than any other country. Yet, 45 percent of Americans suffer from one or more chronic conditions, and this number is growing.2 Today’s taxpayers and patients demand more information to make informed decisions about their care and its cost–asking fundamentally whether they are getting value and the desired outcomes from their spending.
Enter VBC. The health care industry has been talking and hearing about VBC for several years, but the time for talk is quickly shifting to a call for action. The volume of payment under VBC models is chipping away at traditional fee-for-service models. Why? A combination of government pressure and marketplace forces is compelling both payers and providers to align on VBC solutions to achieve better care, healthier populations, and affordability.
At a higher level, though, VBC is not just about government-mandated payment negotiations between health plans and providers. It represents an opportunity for health plans to add value for members and deliver a more personalized experience, with greater influence, contribution, and visibility to the quality of care members receive and the efficacy of treatments.
While most industry participants understand the concept of VBC, not all recognize the transformative impact on their organizations in terms of the:
- culture shift requiring new strategies aligned to the organization’s lines of business, markets, and model types.
- data-driven processes to minimize risk and optimize performance
- interoperable systems that will need to be re-engineered as payment models transition from fee-for-service to alternative payment models, and transparency across plans and providers–and consumers–become the standard
- required expertise to understand the full spectrum of what is needed to enable VBC from both a strategic and operational standpoint
As the national director of provider innovation strategies, Adele Allison monitors health care reform for SS&C Health’s health solutions division and is a legislative/regulatory subject matter expert. Having served as the co-chair of the HHS ONC Beacon-EHR Vendor Affinity Group, Allison is a member of HHS’ WEDI board of directors and current co-chair for the WEDI Payment Models Workgroup. She has nearly 30 years of health care experience and is an active participant with HHS’ HCPLAN. A published author, Allison is a member of UAB’s advisory board on curriculum development and served on UAB’s HITECH Committee for health IT curriculum development; and, is the president for the board of directors for Alabama HIMSS.