Payers Increasing Member Value Through Payment Initiatives

Payers are greatly impacted by the healthcare payment trends. In InstaMed’s Trends in Healthcare Payments Seventh Annual Report, 40% of payers rank direct-to-consumer payment solutions as their top priority in 2017. Responses to these trends include payers increasing member value through value-based payment initiatives.

Payers Increasing Member Value

Payers must interact with members in ways they never needed to previously. People spend larger and larger portions of their household income on healthcare and payers share in delivering positive healthcare experiences. Payers will share in the backlash if the experiences, especially the payment experiences, are bad. In another recently released report, Value in Healthcare: Laying the Foundation for Health System Transformation by the World Economic Forum, in collaboration with The Boston Consulting Group (BCG), suggested areas where payers can focus on impacting value.

• Value-based healthcare is a genuinely patient-centric way to design and manage health systems. Compared to what health systems currently provide, it has the potential to deliver substantially improved health outcomes at significantly lower cost.
• The fundamental principle of value in healthcare is, first, to align industry stakeholders around the shared objective of improving health outcomes delivered to patients at a given cost, and then to give stakeholders the autonomy, the right tools and the accountability to pursue the most rational ways of delivering value to patients.
• The report suggests three foundational principles for value-based care:
  • Measuring outcomes and costs
  • Focusing on population segments
  • Customizing segment-specific interventions
• Four enablers are key to accelerating the adoption of value-based healthcare:
  • Health informatics: facilitating the easy collection, analysis and sharing of outcomes and cost data
  • Benchmarking: leveraging data on outcomes and the costs for clinical practice improvement and innovation
  • Value-based payments: creating incentives for all stakeholders to focus on value
  • Innovations in organizing care delivery: improving coordination across the health system

Bundled Payments

Bundled payments serve as an entry to value-based care because of the relatively low risk to providers. Enough positive data exists to excite those who champion paying for healthcare based on value. Bundled payment models have been around for decades. Although CMS under the current administration is less enthused for bundled payments, the industry trend isn’t likely to stop.

Michael Abrams, co-founder and managing partner of Numerof & Associates, told Healthcare Dive the Health and Human Services (HHS) initiatives have given private payers cover and incentives. Payers support (HHS’) move to bundled payments and other alternative payment models. “Payers want more predictability in the cost of care, and bundled pricing and other mechanisms tying payment to outcomes provide this,” Abrams said.

Abrams said value-based care that requires provider accountability for outcomes and “prudent resource use” are the best way to maintain healthcare costs. “There is no single key to success,” he said. “As with most complex processes, efficiency and superior outcomes require a multidimensional solution, including things like better coordination of care, better preparation of patients and post-acute monitoring, post-acute care differentially prescribed based on patient risk factors, etc.”

All stakeholders need to have skin in the game and enough information to make informed decisions if healthcare is going to deliver better outcomes at lower cost, he said.

Payers are greatly impacted by the healthcare payment trends. Responses to these trends include payers increasing member value through value-based payment initiatives. Click HERE to see how BHM can help meet key aspects for growing value.