Value-Based Care: Getting Patients, Providers, and Payers on the Same Page

value-based care models require alignment between healthcare providers and payers
value-based care models require alignment between healthcare providers and payers

When it comes to evaluating whether treatment has had a good outcome in a value-based care model, patients, healthcare providers, and insurance companies might not always be on the same page.

“A patient’s notion of a good outcome might be different from a technical, clinical measure,” said Mike Albainy, founder and CEO of MD Clarity. “It might just be, ‘Hey, I want to be able to walk around my neighborhood again without feeling pain.’ If somebody achieves that goal, it’s a great outcome for a value-based program.”

Albainy was speaking on a panel discussion called “Are Providers and Payers Ready to Talk Value?” It was part of Xtelligent Healthcare Media’s Payer+Provider Virtual Summit. He was joined by Caraline Coats, Vice President of Provider Alliances at Humana, and David Hatfield, Chief Medical Officer at the Phoenix-based Hatfield Medical Group.

When providers and payers started focusing on value-based care, the metric for success was often achieving a clinical result or meeting a financial baseline. But more and more the patient’s own goals are a main factor. The aim, said Albainy, “is making sure people are getting the right care at the right place at the right time.”

“How do you systematize that?” Albainy asked, noting that the traditional fee-for-service model still predominates. “How do you pull together your financial, clinical, or even spending cost data in an automated way to track the metrics that you care about?”

Making the switch to value-based care is difficult for small- and medium-sized medical practices whose EHR systems aren’t designed to make sure a patient makes it to an appointment.

“That’s the area where they need scalable tools to help them send the right communications to the right people to get them into the clinic or figure out how to follow up on their care,” he said. “You can’t have people doing that manually.”

Hatfield agreed, saying his practice had to bring in chronic care managers to work with patients on their healthcare goals.

“It takes an army,” he said. “It takes an army of engaged people.”

Coats said insurers can help by providing healthcare providers with a variety of options for coverage.

“We don’t have one model,” she said. “No payer does. We’ve thrown a million different models at the providers. The intention is to meet providers where they are.”

Albainy said that for a medical software company like MD Clarity, transparency is the key.

“We’ve strived to figure out a way to show value when a patient is comparing where to go for some treatment,” he said. “We certainly have not cracked that nut fully. But conversations about how we truly measure value and outcomes are really important.”

This panel was recorded and can be watched in its entirety here.

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