"Still, there’s often confusion about who is caring for the patient ... " Playing off of Jimmy the Greek's comment,…
Value-Based Care Can Work When High-Touch, Personalized Care is the Strategy
By Adam Sabloff
Adam Sabloff is founder and CEO of VirtualHealth of New York, NY.
Humana recently released some noteworthy figures related to the company’s value-based care programs. An annual review of the health plan’s efforts reported 27% fewer hospital admissions and 14.6% fewer emergency rooms visits compared with traditional approaches.
That’s good news for the healthcare industry in terms of the sizable investment it has made into evolving pay-for-performance models over the past decade, especially in light of early studies that suggested lackluster returns. In fact, one 2016 study published in the British Medical Journal found minimal evidence to support the theory that value-based care models impacted mortality rates.
The question now becomes: What is driving Humana’s results?
Simply put, the payer’s model is much more targeted than early, broad-stroke approaches to value-based care. They have implemented infrastructures and workflows that identify and address not only the clinical needs of patients, but also social determinants of health that may be keeping members from following through with care plans. This strategy is enabling Humana to achieve higher-touch, more personalized care.
It’s an imperative differentiator that healthcare stakeholders need to embrace heading into the next decade. At a high level, the industry acknowledges that it is on an unsustainable financial course. Yet, alarm bells should be ringing loudly amid concerning statistics related to the silver tsunami, the rapidly-growing aging population that is characterized by a high percentage of complex, chronic conditions.
Consider the following figures:
- The US Census Bureau projects that by 2030, one in every five residents will be of retirement age.
- 85% of older adults have at least one chronic health condition and 60% have at least two, according to the National Institute on Aging.
Demand for long-term services and supports (LTSS)—an area of high-touch care that currently supports more than 12 million elderly and those living with disabilities —will increase in tandem with the aging population. Consequently, providers and payers must embrace the concept of whole-person care models that consider not only broad clinical strategies that promote wellness, but all the socioeconomic needs of each patient. For instance, Humana attributes much of its success to its ability to identify challenges stemming from social determinants of health—such as food insecurity or social isolation—and help patients access services and make better health choices.
Having insights into social determinants of health (SDoH)— the non-clinical factors that make up 80% of overall health—will continue to characterize success with value-based care, which is crucial for healthcare stakeholders to know. Broad-based approaches to improving population health that may promote regular wellness checks and follow-ups only go so far. In the case of LTSS, many elderly patients who live alone and are no longer able to drive will have difficulties picking up prescriptions or getting to doctor’s appointments. Addressing their lack of transportation can have a significant impact on readmission rates and emergency department visits.
In addition to whole-person care, providers and payers need to address the 5% of patients who require critical, complex, and chronic care, who account for approximately 50% of total spend. After recognizing the shortcomings of traditional care management models implemented alongside legacy technology, some stakeholders are turning to a “wedge” strategy that addresses the needs of complex care populations. The approach carves out the subsets of their member population that have complex care needs and places them on an auxiliary tech tool that surrounds them with a comprehensive care ecosystem capable of effectively addressing their needs.
The healthcare industry has made enormous strides over the past decade to usher in better approaches to care, and there have been many lessons learned. One important lesson is that optimal care considers the whole person, and care managers must have insights into facets impacting outcomes—clinical, behavioral, and social—to impact performance in a meaningful way.
As providers and payers turn the corner into a new decade, it’s important that all reflect on successes, failures, and new opportunities, acknowledging and embracing the promise of high-touch, personalized care for complex patient populations.