The traditional fee-for-service model of healthcare delivery has made way in recent years for new, value-based payment models that incentivize quality over quantity. For too long, we have paid for care based on the amount of services a patient received, often ignoring the value or quality that those services provide. But now, we’re in the midst of a shift across the industry to value-based reimbursement agreements that put the consumer at the center of the financial equation and incentivize high-quality care. This past week, I had the honor to join doctors, payers, policymakers and other healthcare stakeholders at the West Health Healthcare Costs Innovation Summit in Washington, DC, and share the Anthem perspective on the changes we’re seeing in the way we pay for care.
The Payer-Provider Relationship
Value-based payment reform put a heavy amount of responsibility on care providers to lead these efforts. But the payer-provider relationship is changing. As payers have implemented value-based contracts, the relationship with care providers has evolved to be more collaborative. Anthem recognizes that a one-size-fits-all approach to value-based contracts doesn’t work, which is why we are sharing information and data that enables care providers to point members to the highest quality care. Payers may better serve and work with care providers by providing a menu of options that allow care providers to tailor payment models to the needs of their patient population.
We must engage all healthcare stakeholders in the evolution and ideation of payment models. Consumers, employers, providers and others should be brought into the development process early on for value-based care and reimbursement agreements to work. Payers need to ask the right questions of care providers and others to ensure that value-based contracts work, and that they are flexible enough to meet the demands of a changing healthcare environment and of consumers who are becoming more engaged in their care and conscious of their healthcare dollars.
As the healthcare system moves to value-based contracting, payers must work to ensure different value models are being deployed and integrated in a way that enables them to function cooperatively. In recent years, Accountable Care Organizations (ACOs) have formed, payers and care providers have implemented bundled payment models, and new networks are forming – but in many cases these efforts are happening in silos. As value-based care evolves, we need to align incentives, apply lessons learned across different models, and work to find a balance between flexibility and common measures of quality so that all value-based models can be knit together and engage the entire healthcare community.
When the Getting at Volume: Provider Payment Models – Where is the Value? panel kicked off at last week’s summit, everyone agreed that we’re at a crossroads. The healthcare industry has one foot in the fee-for-service canoe, and the other foot in the value-based contract canoe. The move to value-based care won’t happen overnight, but the work is already in motion. In order to move the first foot into that second canoe, payers must work collaboratively to shape these new contracts in a way that helps consumers see a difference in their care. We’re doing this work to empower consumers to become more active participants in their care and to deliver a simpler, higher-quality consumer experience.