Healthcare is changing. Pushed forward by the digital revolution, we are witnessing a huge shift towards customer-centricity. At the May edition of Healthcare Payers Transformation Assembly, this was a major theme throughout the discussions.
Supporting Consumers in Value-Based Care
A post-reform environment in the United States and evolving reimbursement models in other developed countries in the EU and North America have placed increased emphasis on the definition of value-based healthcare benefits. There are emerging reimbursement methods that seek to compensate providers based on value rather than volume.
Included in these reimbursement models are value-based reimbursement (VBR), pay for performance (P4P), episodic payments, and global or bundled payments. As of today, there is no industry consensus regarding a standard reimbursement model, although pay for performance has traction in the United States.
The associated challenge for payers is to follow the evolving reimbursement model trends and evaluate the best fit for their business, provider contracts, and member population requirements. This is not an easy task because first, there is no current industry-accepted standard across all member populations and circumstances; second, government entities, particularly the U.S. Centers for Medicare and Medicaid Services (CMS), continue to evaluate and implement specific reimbursement models for defined populations and circumstances; third, the majority of core payer application systems do not support multiple models of emerging reimbursement models, Emerging reimbursement models represent “uncharted territory” for payers.
When discussing value-based care, it’s important to remember that:
- New quality and payment models will be explained to consumers in meaningful ways to best support their navigation and use of the care delivery and insurance systems.
- With increased pressures to improve outcomes, Payers will invest in quality, payment, and billing systems to support new reimbursement models.
- Adjusting business and information sharing processes to accommodate emerging reimbursement methods and adjust the delivery and payment of care accordingly.
- Communicating the details and benefits of these models to providers and consumers. Emerging shifts in the healthcare industry as a result of technology and growing consumer centrism.
Overcoming Cultural Barriers to Health Engagement
When we discuss customer-centricity in healthcare, it’s vital to discuss patient engagement.
To do this it’s essential to understand cultural context when engaging diverse populations to take action in their healthcare. Like you, many of our clients recognize engaging culturally diverse populations need to go beyond just translation needs.
The notion of patient engagement is in its infancy, but we know it’s already having significant economic impact for payers. Getting patients engaged in their own healthcare minimizes complications and lowers overall health care costs.
Patient engagement is an evolving concept. One that we are looking forward to discussing at the Healthcare Payers Transformation Assembly over the next two days.
We have already witnessed how patient engagement can help payers offset losses from the Affordable Care Act exchanges. Late last year, the CMS announced the creation of their own Person and Family Engagement Strategy.
With the digital revolution came the ability to gather extraordinary amounts of data.
When considering value-based or risk programs, health plans must develop a capability to acquire and use a shared data asset with their provider networks that include timely, deep, high-quality EHR data commingled with claims. The data asset can serve as the trusted foundation for both medical expense/MLR and quality improvement programs, supported by increased provider engagement in pay for performance.
Digital Transformation Insurer: A Mentality & Culture of Digital First
Digital Transformation in the payer landscape is coming.
The thought of billions of devices connected to the Internet is scary, especially for insurance companies with old legacy systems and data privacy concerns. The number of devices connected to the Internet continues to grow exponentially, your organization’s ability to analyze the volume of unstructured data will need to increase, and developing a robust, big data analytics strategy will become even more critical.
When thinking about the pace of innovation and change in healthcare, many payers are now looking to partner with or invest in start-up companies, but doing so requires a different skill set than those they have typically utilized previously. This workshop will discuss the how and why of partnering with the early stage ecosystem, as well as review the multiple dimensions and strategies an in-house venture program may utilize when doing so.
Population Health Success
To find financial and operational success in value-based payment models, we must move beyond “Value 1.0” of utilization management, towards “Value 2.0” of population health management. Accurately defining at-risk populations requires data-sharing from payer to provider, using both retrospective and predictive analysis. Managing the at-risk populations requires a collaborative, process-oriented approach between carefully selected representatives of payer groups, provider groups, and care management teams, across the entire continuum of care. Through a process-oriented approach, provider-payer teams can identify and address gaps in capability and communication, which are most commonly at the root of population health management problems.
Thank you to all our speakers, sponsors, delegates, thought leaders, and partners for the making the event a great success!
Recap of the assembly from Twitter and Instagram – #PAYAssembly
ABOUT HEALTHCARE PAYERS TRANSFORMATION ASSEMBLY
The Millennium Alliance is pleased to announce that application for our biannual Healthcare Payers Transformation Assembly is now open. North America’s most prominent IT and business leaders from the Healthcare Insurance industry will be gathering on December 7-8, 2017, to discuss how to adapt to the industry’s customer-centric makeover.
Back in May we were joined by industry heavyweights like Henry Chao, Retired CIO & CTO, Centers for Medicare & Medicaid Services, to discuss the technological advances in genomics, personalized healthcare, AI (and more!), coupled with consumer demand for greater price transparency, have changed the face of healthcare in North America. The need for the Healthcare Insurance industry to adapt has never been greater.
Across a series of executive education roundtables, keynote presentations, collaborative think tanks, educational workshops, and networking sessions offering insight into industry-specific topics and trends, we will be taking these conversations one step further, helping you stay one step ahead.
This is not just another “Healthcare” event. Spaces are reserved for the best in the business. Enquire about attendance here!