While private investment into value-based care organizations more than quadrupled between 2019 and 2021 (McKinsey), many provider organizations still lack the capabilities and tooling to make the move to value or expand to richer, more sophisticated contractual arrangements (e.g., moving from pay for performance to global capitation). The capabilities required need to address the core challenges of these organizations, including the following.
1. Evolving populations
Populations across the U.S. are projected to become more diverse over the next two decades, making it even more important to have a deep understanding of the unique community and social challenges that impact healthcare outcomes. According to Deloitte, up to 80% of outcomes are affected by social, economic, and environmental factors.1 Regulations and quality programs are constantly changing (i.e., Medicaid redeterminations, Risk Adjustment, Stars, HEDIS). For example, Healthcare Effectiveness Data and Information Set (HEDIS) measures were most recently updated to include race and ethnicity data to address care gaps and health inequities in health plan performance. Regulatory entities are stratifying their approach to measurement, and organizations must react in turn. Investing in member engagement platforms that can reach and engage diverse cohorts at scale has shown to be critical at the individual level, earning the trust of diverse membership and driving behavior change.
2. Unsustainable processes and point-solution challenges
Many organizations are plagued with costly, labor-intensive processes that were built out of necessity and immediate needs. Point solutions were seen as the solution, but the proliferation of these solutions often leads to more administrative burden and uncoordinated workstreams across an organization. This is unsustainable.
While payers and providers recognize the limitations or challenges of their existing solutions, many are overwhelmed by the prospect of introducing a new platform to their teams and the potential lengthy implementation period that comes with it. They need a platform solution that can be implemented immediately without completely upending their operations, while working to phase out and streamline the manual processes incrementally based on their transformation appetite.
Optimizing processes for value-based care
Value-based care can and should accelerate in the future, but the capabilities delivered by platforms need to meet the unique, multidimensional needs of value-based-care-forward organizations.
Born out of the needs of the modern healthcare organization, +Oscar’s Campaign Builder helps clients deliver quality care at scale with a more personalized, omni-channel and value-focused approach to engagement. Campaign Builder drives high-value member behavior change through encouraging nudges, time-sensitive interventions and multi-step clinical journeys; through HIPAA-compliant messages across channels such as SMS, email and Applets; and through integrations with third-party EHRs and CRMs. With a typical implementation timeline of just under 12 weeks, clients can augment and enhance their existing processes quickly to see results, and over time, consolidate and streamline their operations.
Delivering quality care at scale requires the capabilities to speak at the individual level while reaching the masses. Utilizing a next-best action framework and personalized content, members enroll in journeys unique to their individual needs. Through an integration with Chat GPT, Campaign Builder can automatically utilize member demographic information and data on how members have engaged with different communications in the past to select the messaging or channel most likely to resonate with a member.
Results to date have provided clients with clear proof of their ability to activate members and patients and deliver outcomes:
- Primary care utilization – 10% increase in primary care provider utilization for a large, value-based primary care group
- Diabetes gap closure – 40% increase in diabetic eye exams for Medicare Advantage population
- Reduction of emergency room visits – 13% ER visit reduction for a diverse, heavily subsidized individual population
Campaign Builder has been transformative for partner organizations striving to become industry leaders in value-based care, but it has also increased the satisfaction of patients, providers and internal staff.
Conclusion
Best-in-class value-based care organizations, or organizations striving to be best-in-class, can implement solutions to meet the evolving demands of the market, regulatory bodies and diverse populations and deliver business outcomes. Platform solutions that provide robust capabilities to personalize and enhance the member experience are needed to drive the behavior change necessary to deliver on value-based agreements.
