As providers improve quality and outcomes, they must intensify efforts to retain patients. Providers investing in care redesign, quality and outcomes should ensure they reap the benefits of these resources by keeping patients with them for many years. C-suite leaders see a need for new and innovative member/patient-retention programs and rewards. The good news: as consumerism becomes the norm in health insurance decisionmaking, providers are more in control of their relationship with consumers than ever.
As more consumers use the insurance exchanges, providers should prepare for multiple scenarios. The insurance market is changing quickly because of consolidation, employer demands and the expansion of narrow provider networks. Approximately 47% of the health plans offered on Affordable Care Act insurance exchanges in the 2013-14 season were narrow- or ultra-narrow network plans. Providers must be prepared to articulate their value to multiple audiences; consider jumping to direct employer contracting; offer innovative, market-specific, risk-sharing models; or set up their own health plans.
In a value-based world, care delivery will occur outside hospital walls. In the not-so-distant future, people will not care how many beds hospitals have. Rather, they will want to know how provider-led organizations are creatively using outpatient resources, nontraditional scheduling and technology to appropriately direct care. We foresee that providers will be rewarded for redeploying existing physical assets in new and innovative ways that meet community needs.
Providers need to continuously prepare for Care Redesign 3.0. Care model redesign is not a one-time effort. Rather, it embodies all the principles of continuous quality improvement. Advanced value-based-care practitioners will not be afraid to construct or deconstruct care models based on populations served, outcomes achieved and contract changes. We have noticed that the cycle times for care model change—big and small—are speeding up as organizations optimize their performance.
Providers may need to retool the executive suite to address value-based care. As providers accept greater financial risk for patients and populations, they will need front-line leaders with both insurance and clinical experience. We are noticing an increasing demand within provider organizations for these dual skills, as well as actuarial, contracting and clinical integration expertise. In 2015, this will be even more critical as the healthcare market continues to undergo enormous change with ongoing provider and system consolidation, expanded ACA exchange participation, increased cost pressure and the steady drive to improve outcomes.