Over the past decade, the industry has experimented with ways to move dollars from fee-for-service care towards value-based care (VBC) structures that improve outcomes, reduce unnecessary spending, and foster better experiences for patients and providers.
Through trial and error, the industry has refined its approaches to value-based reimbursements and tailored its efforts to meet the unique needs of different specialties, care settings, and patient populations. In a time of rapid evolution and growing pressures, several trends will guide the next phase of VBC. These include a shift towards commercial payers’ alternative payment models (APMs) that leverage disease-specific data and population health analytics, practice transformation tools, and new reimbursement strategies.
Next-gen APMs: Creating collaborative, data-first connections between plans and providers
The next generation of APMs will be “data-first” to create the value we need in the market. That means plans must take on an enhanced role in equipping providers with valuable data in near real-time – and the right infrastructure to access actionable insights when and where needed.
One such program is the Oncology Medical Home Plus (OMH+) program, created for Elevance Health’s affiliated health plans and administered by Integra Connect. As part of the program, Integra Connect equips participating practices with critical capabilities. These include:
- Identifying qualifying member episodes in near-real-time
- Analyzing and benchmarking cost and utilization data
- Tracking performance against program quality measures
“Elevance Health works with partners – such as Integra Connect – to deliver innovative, digital-first technologies and data-driven insights that will transform healthcare into a more proactive and personalized experience that contributes to better health outcomes,” said Chris Day, President of Value-Based Solutions at Elevance Health.
Embracing transformational behavior change as a predictor of VBC success
VBC adoption isn’t just a financial transition. It’s also a new way of viewing the relationships between patients and providers, providers and health plans, and health plans and their members.
As APMs start to account for a greater proportion of reimbursements, all members of the care continuum will need to embrace transformational behavior change. This includes new ways of interacting with data, outreach to patients, and collaborating to manage individuals in a proactive, end-to-end manner. This is practice transformation, a process that drives observable and measurable changes to practice behavior.
Integra Connect includes digital practice transformation services in the oncology APMs it manages. The services give participating providers technology-driven tools and best practices that help them become high-performing, patient-centered oncology medical homes. Armed with insights from our experts, OMH+ providers will have protocol-driven analytics and quality measure dashboards, enabling them to identify gaps in care, collaborate on quality improvements and outcomes, and generate evidence to support VBC strategies.
“Historically, healthcare has been siloed, but we are now at a turning point where we can use data sets with clinical and claims information, digital technologies, and partnerships across the healthcare ecosystem to help deliver high-quality healthcare services,” Mr. Day said.
But, that’s just the start.
“At Integra Connect, we want the entire oncology ecosystem – providers, payers, and life sciences companies to harness real-world clinical and claims data for their decision-making,” said Cory Wiegert, Chief Operating Officer at Integra Connect. “Our APM work, with Anthem and other commercial payers, can enable the entire industry with the data and insights they need to improve care and patient engagement, support quality initiatives, and identify and enroll patients for clinical trials – which will advance VBC in oncology by lowering the total costs of care.”
Embracing new payment models to drive savings and outcomes
At the start of the VBC revolution for oncology, both Medicare and commercial plans used retrospective payments as the primary reimbursement mechanism, with varying degrees of success. Today, commercial payers are looking to provide financial incentives to oncology providers who prioritize patient-centric oncology care and drive better patient outcomes.
In the future, we will see prospective payments gain traction. Prospective payments provide more transparency and predictability for providers. They are particularly beneficial in the specialty space, where bundled payments have been used for years to curb spending on well-defined episodes of care, such as cancer treatments.
APMs are here to stay, but they will continue to evolve as the industry gains more experience around best practices to improve outcomes and control costs. As plans, providers, and patients work together more efficiently, we will have the opportunity to achieve real value across the entire continuum of care.
To learn about the latest APMs, click here.
Sponsored by
Integra Connect is a value-based, precision medicine company that leads the industry in RWD and analytics capabilities for oncology. With clinical and claims data, deep expertise, and sophisticated technologies, it enables providers, payers, and life sciences companies to improve outcomes, decision-making, performance, and research endeavors. For more information, click here.