Accelerating the Move Toward Value: Strategies for 2019 and Beyond

In his first remarks on value this past spring, HHS Secretary Alex Azar made a bold statement about the urgency facing those of us who work in health care. “This is no time to be timid,” Azar told the Federation of America’s Hospitals. “Today’s health care system is simply not delivering outcomes commensurate with its cost.”

Strong collaboration among payers, providers, and other key stakeholders builds the momentum necessary for health care consumers to receive greater value from our nation’s health care system. The past decade has seen advances in payer–provider collaboration and data sharing that reflect clinical, economic, and administrative alignment. What’s needed now is a deeper level of commitment to drive sustainable improvements in quality and cost.

Payers and providers can take three key actions to accelerate value creation in partnership with other key stakeholders in 2019.

Leverage each other’s resources—and those of community service agencies. Research on social determinants of health—the social and economic factors that affect about 60% of health outcomes (estimates vary)—shows that payers and providers would be more likely to address these factors if they could point to a return on investment from their efforts. Evidence also suggests, however, that the SDOH investments by payers and providers often duplicate existing community services because local resources are unreliable or their availability is not well known.

Payers and providers should seek ways to partner with community service agencies and employers to address the social and economic factors that influence effective chronic disease management. Opportunities exist to leverage data from a variety of key stakeholders to identify unmet needs or to jointly fund initiatives that have the potential to improve population health. When payers and providers work together with other interests and groups in improving value, they can make a deeper impact on member health and well being.

Commit to shared-risk arrangements—and provide the data necessary to support these arrangements. When health care claims data are combined with clinical data, employer health- and wellness-initiative data, and consumer-reported data (e.g., data voluntarily reported through wearable health technologies), a view of the quality and cost of care for complex populations emerges. This view is critical to measuring the value of this care. A broad perspective also establishes the foundation for targeted interventions that improve health for member populations—and ultimately reduce costs. For example, in Chicago a collaboration between Northwestern Medicine and Cigna provides Northwestern clinicians with daily access to data that identifies members who may be at risk of readmission, overdue for health screenings, or haven’t refilled prescriptions.

Organizations pursuing a similar approach may wish to consider partnering with members to add insights from wearable tech devices, which have the added benefit of decreasing sick days by 44% among members who wear them daily.

Develop a tightly integrated approach to care management. Quality-improvement efforts are often hindered by the overwhelming volume of metrics that exists. Payers, providers, and employers should agree on a carefully curated set of shared quality metrics. These metrics should form the foundation of a care management model that:

  • Uses high-tech tools to engage members in managing their health
  • Eliminates duplicative services
  • Maintains open lines of communication to both communicate progress toward goals and course-correct as needed.

Accelerating momentum toward value is a joint effort for all health care stakeholders. Shared commitment, insights, incentives, and approaches establish the type of partnerships that culminate in improved clinical and financial outcomes.

Emad Rizk, MD, is president and CEO of Cotiviti, a health care information company based in Atlanta, and a member of the Managed Care Editorial Advisory Board.

After 28 years of publishing, our last issue of Managed Care was December 2019.

While sad, we have much gratitude for the many writers, editors, researchers, reviewers, salespeople, and advertisers who kept us going and made Managed Care a standout publication. And not to be forgotten, we thank you for reading our publication and visiting our website.