Health insurers are struggling to get success in a value-based care reimbursement model. This may benefit from population health management, patient engagement, and healthcare delivery reform.
When payers started to transition to value-based care reimbursement from the traditional fee-for-service payment system, some healthcare executives and financial experts might find that it takes longer than expected to adopt the new payment structures while they overcome some uncertain blocks. Payers may need to follow best practices to get transition more successfully toward a value-based care reimbursement system.
Patient population evaluation
Some strategies payers can use in evaluating patient populations include:
- Patient risk stratification
- Population health management analytics
Payers could help to inform providers on which members are in need of greater engagement in their chronic disease management. Using population health registries for tracking a patient’s progress can also be beneficial.
Population health management can prevent payers and providers to decrease less important spending by tracking patients more closely to make sure preventive services are provided before a patient’s diagnosis worsens and he or she ends up in a costly emergency room visit.
Financial Risk Management
When providers partner with payers through a value-based care payment model, they’re often required to take on more financial risk as opposed to payers taking on more risk in a fee-for-service model. The report suggests for payers to transfer financial risk onto the provider in a slow and incremental fashion while the providers advance their care management strategy.
Healthcare Delivery Improvement
The goals of value-based care reimbursement improve the quality of care and contain reducing healthcare spending. Results show that investing in accountable care organizations or patient-centered medical homes leads to a decrease in wasteful spending and a rise in quality, according to Blue Cross Blue Shield.
Measure Quality and Goals
Healthcare providers always focused and have their own quality improvement goals for their patients. Payers could more effectively transition to value-based care by aligning their quality measures to fit the goals of their provider networks.
Payers can instead of forcing providers to adhere to differing quality metrics between public and commercial health plans, payers could customize their quality measures to align with that of the Centers for Medicare & Medicaid Services (CMS) and MACRA regulations.
Blue Cross health plans, for example, provide their members with the necessary information to find the best doctors and hospitals to fit their needs. Using new technology like mobile and digital health tools in engaging members through data-driven updates to help them make the best decisions in their healthcare purchasing.
Using this information health insurance companies can have success in their value-based care reimbursement plans.
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