The COVID-19 pandemic has upended the healthcare system as we know it, laying bare the troublesome consequences of our ongoing struggle to deliver equitable, patient-centered, value-based care to all Americans.
Fortunately, there are a few bright spots—the rapid expansion of telehealth technology, for example, has dramatically increased access to care in convenient, patient-friendly ways. And a new, unconventional alliance between employers and healthcare systems could help to accelerate more solutions for our long-standing challenges with care coordination and value-based care.
Within our fragmented system, employers and healthcare providers typically interact with multiple stakeholders—health plans, consultants, brokers—to support their mutual goal of a healthy and productive workforce. But the status quo has its challenges. Sometimes the interaction can be as effective as the old game of "telephone" played with string and tin cans, widening the gap between those who pay for care and those who provide it.
Self-insured employers and healthcare purchasers in five cities have been meeting with physicians and other providers over the past year to share their experiences and challenges with our current system. Sponsored by the Council of Accountable Physician Practices, a coalition of leading medical groups, and the National Alliance of Healthcare Purchaser Coalitions, these forums were designed to build a framework for improving communication between providers and employers.
Pain points with the healthcare system
Employers identified serious pain points they have with our healthcare system, including lack of care coordination when employees are ill; limited access to specialists and behavioral health providers; disjointed customer experiences; excessive costs; and the inability to determine the value of healthcare spending.
While these employers fully recognized the value of prevention to keep their workforces healthy, they also understood that the current healthcare system is not optimized to achieve this goal. To help close care gaps, they are often forced to purchase essential "add-on" services separately, such as wellness programs, telehealth and care coordination. Lack of transparency has resulted in a growing mistrust among all system stakeholders—especially providers, employers and health plans.
In the listening sessions, it was clear that employers were not being fully informed about the standard features of integrated healthcare systems—physicians, hospitals and others organized to deliver coordinated, patient-focused healthcare—when many features of such systems would directly address employers' top concerns.
Benefits of integrated, value-based care
Care coordination for patients with chronic conditions is standard in most integrated delivery systems, as part of their population-based health-management programs. The widespread use of telehealth enables access to services across geographies and specialties. Physicians and other clinicians, bolstered by a culture of team-based care, are connected by electronic health records and other technologies to support a seamless experience and better health care outcomes.
When presented with healthcare benefit options and network information by their consultants or brokers, however, employers often do not learn about these features. Without knowing what is on the menu, employers cannot order the kind of healthcare they want.
This disconnect between providers and employers means that another fundamental issue remains unaddressed—the acceleration away from fee-for-service medicine to value-based care. Employers recognize that fee-for-service contributes to the fragmentation of services and communication, and can drive overutilization without improving care quality.
While many health systems are already firmly on the journey toward outcomes-based payment, further dialogue will help to clarify for employers what value-based care really means and how it can solve many of their healthcare challenges. Employer support for progressive, value-based payment arrangements will rapidly accelerate their adoption and dramatically improve health outcomes.
More than 150 million Americans have employer-sponsored health coverage. It is essential that dialogue between employers and providers continues so that we can come up with new solutions to the access, coordination and value problems that healthcare purchasers face in our current system. The discussions can help close the divide between unfulfilled expectations and real solutions, moving us closer to our common goal: providers and employers working together for a healthier America.