THE 'EDGE REPORT BLOG

Key Takeaways from AHIP Institute 2018

Hundreds of health plan executives, sponsors and others assembled June 20 - 22 in in San Diego, CA to discuss and share with each other a wide variety of issues affecting the industry. Below are two key takeaways from the conference.

 

Payers, Providers, and Pharma Need Tighter Alignment on Analytics to Improve Care

Providers, health plans and pharmaceutical companies need to get more aggressive in sharing risk, however it’s not always feasible to access the necessary data.  Getting started, various stakeholders found they could get aligned on metrics for very simple contracts so that foundational benchmarks could be established.  For example, they wanted to compare if a patient was responding to a medication the same way a patient did in clinical trials. Also, did the patient realize a benefit from the medication against their disease, and if they did, how should a reimbursement be set-up around that benchmark. It’s necessary to establish baselines to make these assessments. There is typically data available to assess the impact of a medication on a patient 3-months out, however longitudinal benchmarks for 6-, 12-, and 18-months out need to be defined. Creating these benchmarks will allow intervention with a patient so that a contract’s outcome can be positively influenced.  Introducing a neutral third-party analytics provider between the provider, health plan and pharmaceutical company adds a level of scrutiny and credibility. Health plans should form collaborative relationships with providers so that they can access the data needed to process their contracts. The old ‘blame game’ doesn’t work and certainly doesn’t deliver improved patient outcomes.

 

A key finding from the 2018 Change Healthcare’s State of Value Based Care Survey is that cost savings realized by health plans operating under a value-based model average 5.6%. In 2016 Change Healthcare surveyed that only 52% of health plans were operating under a pure fee-for-service approach and that number had been forecast to fall to 41%.  Looking back, it was found that only 37% of Health Plans are still operating under a pure fee-for service model, indicating the adoption of VBC is accelerating faster than anticipated. Sharing risk has emerging as a trend in successful value-based care programs with commercial lines of business leading the way. The analytics to identify costs are overwhelming developed in-house however, 42% are not satisfied with the tools they are currently using, indicating a strong opportunity for improvement for tools.

INFO SHEET
Value-Based Healthcare is Here to Stay

Value-based reimbursement (VBR), has grown in adoption to constitute a true transformation in the delivery of and payment for healthcare services in the United States. Read our this informative info sheet to learn how doctors, hospitals, health plans, post-acute providers, and others in the healthcare ecosystem have taken VBR past the early adoption tipping point and right into standard practice.

Everyone Agrees – Health Care Must Address Social Determinants of Health to Improve Population Health

With over 80% of health determined by factors outside of physical healthcare, organizations need to focus on engaging patients in focusing on those variables to improve their own health. Incorporating social needs into health can help connect patients with their communities and access resources that may seem inaccessible or unaffordable, but vital to their health. Focusing on the social determinants of health can help to plan ways to provide quality and affordable care. Kaiser Permanente is focusing on one factor – housing stability, with an investment of $200 million to prevent homelessness in lower to middle income households. Housing stability, a key factor in well-being, will enable patients to live in a consistent and healthy environment and establish themselves as part of the community. Additionally, on-demand transportation groups like Uber and Lyft have become a vital resource in addressing access to care by providing non-emergency medical transportation to help patients make it to appointments. Uber’s launch of Uber Health works with healthcare organizations to coordinate travel for patients to and from appointments. Evaluating the return on investment of these socially focused health programs is new because there are typically longer-term benefits of, for example, making it to a doctor’s appointment.  There will be short-term and long-term benefits of these innovative programs and we likely will see the payoff down the road.  However-  if we don’t begin to address the social determinants of health, patients will be driven toward existing government programs that can’t accommodate the number of patients requiring their services. Providing better healthcare is going a community effort. We need to consider “How can we do better as a community?” Breaking down boundaries and bridging the gap between physical and behavioral health providers will minimize duplicate services, prevent lower health outcomes and improve the patient experience.

 

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