Top Issues Facing Payers on the Journey to Value

We recently held our biannual payer client conference in Orlando, FL, and it was another very productive meeting. Several plans shared their respective progress and challenges as they each journey forward on the path to value. Based on the feedback, my colleague, James Lawson, Vice President, Client Experience, Payment and Population Solutions, shared some key takeaways from the meeting:

Everyone is seeking performance analytics – both early and late adopters.

We noticed that the gap among our commercial clients has closed. In years past, we would have one or two plans significantly further along with value-based programs than others. But this year, everyone is feeling market pressures and looking to us for answers quickly. At no other point was this more apparent than during the discussions about healthcare analytics. The group agreed that they are all looking for a more standardized approach for analytics as a starting point to providing performance feedback to providers and enrollees alike.

Aligned incentive contracting is on the rise.

Blue Cross Blue Shield (BCBS) Minnesota’s aligned incentive contract (AIC) is the plan’s program for rewarding their providers on the value of care they deliver. We’re seeing many more commercial plans follow their model, whether it be a shared savings arrangement, risk sharing, or a full risk program. Additionally, BCBS Minnesota is continuously working to give providers better analytic tools to support the AIC program.

Plans and providers are investing in predictive analytics.

Commercial payers realize they cannot do this alone—that is, no amount of price pressure is going to work without a comprehensive approach to helping physician practices adapt to change. If plans are going to incent their providers on performance and cost, the plans need to invest in the necessary processes and procedures within the office. The solution? Both plans and providers are seeking predictive analytics.

But are predictive analytics just the shiny new toy, or are there models that can help plans and providers understand which patients are at greatest risk of high costs and poor outcomes? BCBS Nebraska outlined how they’re using a predictive model to determine and follow up on persistent high-cost enrollees—and it has already changed their approach to case management.

Patient engagement is increasingly critical to value-based care.

Finally, our payer clients discussed the importance of engaging members in maintaining and improving their health. Health risk assessments, such as HowsYourHealth, developed by John H. Wasson, MD, allow plans and their enrollees to better understand the degree to which health confidence influences health outcomes and total cost of care. Gordon Moore recently wrote about how patient-reported outcome measures can impact the outcomes patients experience.

Barbara A. DeBuono, MD, MPH is vice president, Market Development for Populations and Payment Solutions at 3M Health Information Systems.

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