Ashok Subramanian on Considerations for Employers Designing Value-Based Care Frameworks

Ashok Subramanian, MBA, founder and chief executive officer, Centivo, speaks on the limitations of traditional employer-based health benefit plans in the pursuit of value-based care and what employers should consider in designing these incentives on a community level.

Subramanian recently participated in a panel discussion at the 2022 Greater Philadelphia Business Coalition on Health annual conference titled, “Driving Value through Health Plan Innovation.”

Transcript

How has value-based care integration fared under traditional employer-based health benefit plans and what limitations persist through these models?

So, the challenge that value-based care models have had with traditional carriers, traditional networks, is that, in effect, most networks include every provider—it includes every provider that’s committed to value, drives affordability, is cost effective and high quality. It also includes providers that are not that are not—that are high cost or may miss the mark when it comes to quality scores.

And most benefit designs don't differentiate for the employee, whether that employee should pay more or pay less if they go to those different types of providers. So, ultimately, there's a deep frustration amongst a lot of providers who've committed to value-based care, because in their minds, they're doing the right things, they're trying to control costs, are trying to keep people out of the hospital, they're trying to improve outcomes, avoid complications, avoid recurrence, yet, they're actually paid less and they see fewer patients than they feel like they should, because there's no incentive for people to go to them, as opposed to folks across town who may not be as effective.

So, providers have really embraced new models. Ours is one of them, there's others as well. But I think for providers to get that message through, it is essential that they really understand how employees consume their health insurance, because that ultimately drives whether they're going to get that market share or not.

What factors warrant consideration by employers in designing value-based care initiatives on a community level?

I think there's 2 or 3 parts. So, most employers that we engage with are pretty clear that quality comes first. So, ultimately, employers care about cost, cost is very important, but these employees are their workers, their family members, it's become very hard to attract and retain talent given COVID-19, given some of the other pressures in the economy. And so the most important thing that employers typically look for is I want to save money, but I don't want to compromise on quality.

And so really assessing and understanding and being transparent around quality scores, things that we've talked about already, complication rates, recurrence rates, that's the starting point. The next part is once you meet that bar for quality is: are you committed to affordability? Are you cost effective in your market? Or are you simply charging more because you can, because you own the only hospital in town. Because you're the only provider of cardiac care. And those sorts of examples of market power driving cost up is something that employers are getting much more attuned to now.

And then the third thing is there is this great awakening around primary care, and the fact that the more we spend on preventing disease in the first place, the more that people have a trusted relationship with a primary care physician, a primary care team, the more that primary care is not just about a 7 minute sick visit, but it's about 30 minutes to understand the person, integrating mental health with physical health, having access 24 hours a day in different forms. Those are things that employers are looking for as well and really in our minds, is the bedrock of value-based care as it comes to serving the employer community.