To Eric Swain, the shift toward value-based care models is one of the health care industry’s most exciting developments amid growing quality and affordability concerns.
As opposed to fee-for-service models, which pay providers based on the quantity of services they supply, value-based care reimbursement models focus more on the quality of services offered, which is often defined through patient outcomes such as reducing hospital readmissions.
The shift toward value-based care began around a decade ago with the idea that if insurers and providers shared risk, they could manage patient care more effectively, explained Swain, vice president of sales and account management for UnitedHealthcare of New England Inc.
“The goal here is, how do we improve the quality of care? How do we improve the efficiency of the care that’s being delivered? And how do we make it a better overall experience for the [patient]?” Swain said. “I think this is where care is going.”
While health care leaders understood successfully implementing value-based care wouldn’t take place overnight, it’s gaining momentum now, added Swain, who noted that health care spending “has grown from $20 billion in 2012 to $100 billion in 2023.”
Swain spoke during one of two panel discussions during Providence Business News’ Fall 2023 Health Care Summit held at the Crowne Plaza Providence-Warwick on Oct. 25. Along with the growth in value-based care, panelists discussed mitigating rising costs, addressing inequities and barriers to mental health care.
Panelists agreed that at the core of value-based care is the partnership between insurance carriers and providers. One of the best ways to foster this collaboration is through data sharing, said Dr. Kristin Russell, chief medical officer of Neighborhood Health Plan of Rhode Island.
“[Data sharing is] really important to prioritize in these relationships so that you’re all on the same side of the table and looking at trends together, looking at root causes, breaking down silos and putting the patient first,” Russell said.
Corey McCarty, senior vice president and general manager of CCA Health Rhode Island, also noted that insurance carriers cannot take a “one-size-fits-all” approach to value-based contracting with providers because they may face their own challenges and have different capabilities.
“At the end of the day, you want the provider to be successful and if they’re successful, that means the patients are getting quality outcomes,” McCarty said. “It usually also means, at the end of the day, lower costs and everyone’s trying to solve for that.”
McCarty added that value-based care’s collaborative approach could help alleviate some of the rising health care costs. This is because insurance companies would be more likely to stop some cost-saving methods they have implemented such as setting quantity limits or offering high-deductible health plans that actually created barriers for providers and patients.
“We’ve done things over time out of necessity that have now made health care and health insurance unaffordable,” McCarty said. “You may drop the premium down and make the premium affordable, but the reality is your deductibles, your out-of-pocket maxes are completely unattainable for the average consumer. At the end of the day, we need to rethink how we’ve done that.”
When it comes to controlling costs, Russell emphasized the importance of prevention efforts such as creating incentives for people to receive COVID-19 vaccines and generic medications for chronic conditions without copays. Russell also said that increasing access and proactively treating behavioral health conditions is valuable, as those with coexisting mental and physical health issues tend to be two to three times more expensive to treat than those with just physical conditions.
Among the most effective ways to improve access include reducing the stigma surrounding mental health and integrating behavioral health care within communities and other service options, said Samantha Rosenthal, associate professor in Johnson & Wales University’s Department of Health Science.
“There are things that we can do to [provide] wraparound support for people who need to be actually accessing mental health care, and quite frankly, we need to support that group more than anyone else because they’re not going to be OK with their physical health problems if their mental health problems are not addressed,” Rosenthal said.
Dr. Farah Shafi, executive vice president and chief medical officer of Blue Cross & Blue Shield of Rhode Island, agreed with Rosenthal and said that addressing health care inequities is one of the main reasons she was drawn to her new role at the insurance agency.
“I think it needs to come with the understanding that the health care system has created these inequities over the course of years, and it is going to take years for us to address,” Shafi said. “But we can do that with one initiative at a time.”
The panelists said that insurance companies have begun to take steps toward tackling inequities. These include UnitedHealthcare’s $11 million national grant – including $500,000 for Rhode Island – to improve care for underserved communities. Blue Cross & Blue Shield has also participated in the Rhode Island Life Index survey. And CCA has partnered with Meals on Wheels of RI Inc. to provide food for people who may not be able to leave their homes.
“It really is the thought of embedding equity – especially health equity – in everything we do,” Shafi said.
