By Deepak Valecha, Assistant Vice President - Health Plans & Healthcare Consulting, CitiusTech and Prosenjit Dhar, Senior Healthcare Consultant, CitiusTech
Key considerations for a value-based care maturity model – CitiusTech Perspective
Increasingly, payers are shifting population cohorts to an outcome-based, risk-sharing arrangement. To successfully scale the value-based care (VBC) transition, payers must adopt a multi-stage approach. Despite strong willingness, payers and providers struggle to scale value-based care with persistent ROI. Much has already been written on the payer and provider VBC shift. Reassessing the VBC value chain will enable health plans to transition to higher-level maturity VBC models, achieving scalability, greater efficiency, and more sustainable ROI. This article aims to provide a practical perspective on the journey towards steady state VBC and the change management that should be adopted for a smoother transition.
At CitiusTech, based on our engagements with several payers, we have framed a three-level maturity model. Most payers are devising strategies to transition from maturity level 1: incentive payments based on quality reporting Machine Readable File Analytics for Payers
Achieving Personalized Care for Level Three VBC Maturity
The journey from fee-for-service design to personalized care requires a commensurate shift in focus from healthcare service delivery to patient- and member-specific healthcare service alignment. Key goals to achieve steady state VBC maturity would include:
How Interoperability and Patient-Centered Quality Measures Ease VBC Transition
Two industry developments can make the VBC maturity transition easier.
Interoperability Focus: Recent government initiatives by DHHS, CMS, and NCQA, including Digital Quality Measures (DQM), Digital Exchange of Quality Measures (DEQM), and large-scale public-private collaborations (e.g. DaVinci, Gravity, OHDSI), are focusing attention on creating a seamless payer-provider exchange of data.
Patient-Focused Quality of Care Measurements: Keeping patient-centric principles at its core, digital quality and population health analytics are being redesigned to better anchor clinical process, outcome, and experience journeys. This redesign is based on health equity and individual disease progression like Patient Reported Outcomes Measures (PROMs). Together, these measures will continue to move provider organizational focus toward patient-specific health outcomes versus general compliance.
Transitioning to Level 2 and Level 3 maturity relies on payers assessing, selecting, and adopting VBC solutions that offer transparency, automation, intelligence, and interoperability. In our view, the critical components for a comprehensive, scalable VBC solution span across the following value chain components:
The value-based program management space is ripe for disruption with payers using a mix of manual efforts, spreadsheet-based tactics, and point solutions. Payers will be well-served to define a long-term VBC technology roadmap that aligns with the maturity curve and balances technology investments over the short- and medium-term.
CitiusTech provides seasoned, global expertise in value-based care contracting, operations, and technology to realize better outcomes and ROI through personalized care. Contact us to discuss the three-level VBC maturity model in more detail.