By 2031, the global value-based healthcare industry, or VBH, is expected to be at $43 billion—equivalent to a compound annual growth rate (CAGR) of 17.2% in the next seven years. Healthcare providers’ transition to this model, then, which aims to ensure that patient care and health outcomes match costs incurred vs the traditional fee-for-service approach that focuses on the volume of services provided, is no longer a matter of if, but when. North America is expected to lead the charge, followed by Asia Pacific then Europe.
However, implementing VBH can be complex and resource-intensive. The challenges involve understanding the reimbursement model, and ensuring that there is balance in the utilization of healthcare services, such that patients’ conditions are addressed correctly in order to reduce long-term costs while avoiding excessive spending.
Issues surrounding data integration and interoperability of IT systems, measuring patient outcomes, and resistance to move away from the traditional fee-for-service model also add to the complexity of implementing VBH. However, these likewise present opportunities for providers to innovate by building partnerships that can support such changes.
The prescription for success in value-based healthcare lies in the synergy of care providers and insurers, so that patients receive the care that they need when they need it. Cross off these three key items on your checklist to ensure the smooth implementation of a value-based healthcare system:
1. Data Management and Analytics
In the era of value-based healthcare, data is king. Data management, which includes data analytics, gives providers a holistic view of a patient’s health journey, enabling them to better manage any chronic illnesses or diseases in the long term. A robust data management system, built through electronic health records (EHR), should therefore be in place, so providers can:
- Track key performance indicators and identify best operational practices that deliver optimal health outcomes while reducing costs;
- Measure patient outcomes accurately;
- Determine ideal healthcare staffing schedules; and
- Identify areas for improvement based on patient satisfaction rates.
With only 57 percent of healthcare organizations’ data being used to make strategic business decisions, analytics in healthcare is still largely untapped. The increased adoption of AI and Machine Learning will also play a crucial role in predictive analytics and personalized care. Forming the right partnership with data management experts can provide healthcare companies significant competitive advantage.
2. Administrative Efficiency: Freeing Up Resources for Patient Care
While patients’ medical needs naturally come first for any healthcare provider, back office tasks such as billing and coding can take up resources that would be better targeted toward patient care.; in fact, administrative costs account for 15% to 30% of healthcare spending in the US. Implementing operational efficiencies can help reduce these operational costs, improve accuracy and compliance, and, ultimately, allow healthcare providers to focus more on patient care.
3. Patient Engagement
Engaged patients are more likely to have better health outcomes, with studies showing that disengaged patients incurred medical costs that were 21% higher compared to those who were highly engaged with their provider. Patient engagement solutions can improve patient education and self-management, enhance medication adherence, and facilitate better provider-patient communication.
In the implementation of a value-based healthcare model, these three key support functions can significantly enhance providers’ ability to deliver high-quality, cost-effective care. While healthcare companies are the natural medical industry experts, there is a huge benefit in finding the right partner in data management and analytics; administrative tasks like billing and coding; and patient engagement solutions. Leveraging external support can help healthcare organizations gain crucial insights into patient outcomes, operational efficiency, and areas for improvement, ultimately driving better decision-making and personalized care; free up valuable resources, allowing providers to focus more on patient care while reducing operational costs; and improve health outcomes and reduce medical costs through better patient education, self-management, and provider-patient communication.
A partnership among healthcare providers, insurers, and BPO companies that offer the key support functions they need, therefore, creates a robust ecosystem that enables and fully embraces the principles of value-based care, resulting in improved patient outcomes, increased operational efficiency, and a more sustainable healthcare system overall.
As the healthcare industry continues to evolve, value-based care will play an increasingly important role in shaping the future of healthcare delivery and reimbursement models worldwide–and the time to act is now. At OP360, we offer the right kind of partnership with healthcare companies to help them navigate this complex landscape more effectively, ultimately leading to better patient outcomes, improved financial performance, and a more sustainable healthcare delivery model.
