BW: When it comes to how care is paid for, our nation’s move from “volume” to “value” has indeed been in the works for some time, building from efforts that stretch back decades. For the most part, experts and analysts across the industry reached consensus long ago that the move to value is the future; but in the present, the move has been slow as there is heated debate about how it should work and what comes next.
It’s time to end that debate and focus on the opportunity ahead. Empowering physicians through value-based arrangements improves both the health of people and our healthcare system — and it does so the right way. Increasing the importance of preventive care and reducing costly invasive care, in turn improves health outcomes and lowers costs. Driving this type of transformation is particularly important given the country’s increasing healthcare costs.
AM: There is no doubt that healthcare costs are reaching a tipping point, and the fee-for-service system is unsustainable. But fee-for-service is how our industry functioned for a very long time. What do you say to people who are overwhelmed by such a big change?
BW: Some say the administrative burden of VBC is too hard. And there is some truth to that — as change is never easy. But very few worthwhile things aren’t hard. VBC is worth it because it absolutely does work for consumers, employers, payers, and care providers – and we have proof.
I will also say that skeptics sometimes take the narrow view that VBC is just a payment methodology change — when it really is so much more. We fully believe that VBC helps align everyone in the healthcare system. That’s because it’s rooted in close and powerful partnerships with care providers. It also requires payers to build infrastructure around payment, showing it incentivizes what we and the care providers value — quality and improved health outcomes.
AM: And most importantly, VBC works when it comes to improving health. For example, in our Medicare members, our members seeing a provider who participates in value-based care had 12.5% more annual visits than providers not in VBC. And when it comes to controlling blood pressure and diabetes — members benefitted from a greater than 20% improvement when seeking care from value-based care practices compared to those that are not.
But it isn’t just Medicare — we have seen similar progress for Medicaid members and among commercial members too. Building on such amazing success is what I’m focused on in my role — going beyond contractual agreements and empowering care providers so they can continue to deliver the high quality, affordable care our members deserve. Can you speak a little to the broader point of Elevance Health’s philosophy about working with care providers?
BW: First of all, it’s rooted in forging real partnerships with care providers and as you said, going beyond the contract to create a real impact on health — together. It’s why we invest in contracting for outcomes, collaborating by sharing data and improving administrative processes, and connecting for health via integrating services that improve the whole health of the individuals we mutually serve.
AM: Let’s talk about primary care for a minute. We know that about 80% of healthcare costs flow through primary care providers (PCPs). For providers to be financially successful in a value-based arrangement, they may need to deploy a variety of tactics that go beyond their traditional scope of practice, like monitoring the health of their patient population through data and insights, proactively identifying and communicating with patients who can benefit from additional care, addressing social drivers of health for their patients, etc. Are we at risk of putting too much of a burden on them?
BW: That’s a very good point, as primary care providers are the heartbeat of our healthcare system — and their plates are already full. Independent care providers face particularly large challenges when it comes to VBC. While overall hospitals and healthcare systems have developed the infrastructure needed for transitioning from fee-for-service to value-based care, independent care providers often have a hard time staying truly independent. It’s why we have invested in — and partnered with — “aggregator” organizations which align independent PCP practices, providing them with analytics, technical support, and other capabilities needed to deliver superior care and transition to value-based care.
AM: When people think of VBC, they think of its impact on care providers. How does VBC impact consumers?
BW: The truth is, how payers reimburse care providers shouldn’t be something consumers have to think about. VBC focuses on better outcomes for both patients and care providers — providing personalized, coordinated care — which can shift their healthcare system experience. When we pay based on outcomes, rather than on individual procedures or services, preventive healthcare like annual exams, recommended screenings or even taking an extra 20 minutes with a patient to explain medications become high-value activities for providers. When people get the preventive care they need, care providers have a greater chance of detecting and treating potentially negative health events at an early stage. Value-based care also can lead to a decrease in unnecessary services that put unneeded stress and financial burden on consumers.
VBC is about doing the “right things” to improve health through partnerships with better, data-driven insights and wrap-around support for care providers. VBC enables a future where our care provider partners can be successful in improving outcomes and lowering costs — all while ensuring that people are getting the best access to high-quality care.
AM: If we are to remember just one message about VBC, what would you want it to be?
BW: When we think of value-based care, the payment model in isolation is not a panacea. A strong integrated partnership between payers and care providers is required to move us forward in improving outcomes, advancing health equity, and lowering healthcare costs.