Contributor: Finding the Missing Patient in Value-Based Care

This is the second article in a series on value-based care and the four challenges health care organizations must overcome.

Over the past decade we’ve seen rapid growth in value-based care programs. While some have succeeded in improving quality or lowering costs, none are a scaled program across payer, provider, and the patient much less through different care journeys. An opportunity exists to truly scale the benefits of these programs to the broader patient population. In the first article of this series, we outlined 4 key challenges that health care organizations must address in order to deliver effective value-based care at scale: (i) the missing patient, (ii) the quality illusion, (iii) the capacity shortage, and (iv) the complexity concern. In this article, we’ll take a deeper look at the missing patient.

Despite the growth and development of VBC programs over the years, patient engagement and experience remains immature. That’s what we mean by the “missing patient”—it is the significant lack of patient and caregiver engagement in the design and execution of VBC programs. A study examining patient involvement in VBC programs found minimal instances of collaboration between insurance plans and patients.While the study found some uses of patient questionnaires, more advanced collaborative efforts were rarely used, if at all. Health care delivery must be a 2-way street and patients are eager to increase engagement and improve communication with providers and payers. They need to be involved in how care is delivered. That’s what’s been missing from the equation of value-based care.

Current VBC programs are often seen as a cold transactional mechanism between payers and providers without considering the patient's role in decision-making and how they can help drive their own health outcomes. By failing to include patients and care communities in the overall design of the program, health care organizations are missing opportunities to understand which outcomes are most important to patients and create incentives that enhance patient engagement.

Asher Perzigian | Image Credit: GCI Health

The irony of current VBC is that patients aren’t feeling the savings generated by these programs where it matters most—their pocketbooks. While some patients have received expanded services as part of VBC programs, they continue to face rising out-of-pocket health care costs. When the “savings” generated by these programs remain between payer and provider it creates a 0-sum game. It does not lower patients’ out-of-pocket expenses or incentivize them to make choices that will drive better care quality and outcomes. To continue to scale VBC programs, we need to align the patient’s incentives too.

Solving for the Missing Patient

Designing future programs with patient experience, engagement, and incentives in mind is key to achieving better outcomes and lowering costs of care for everyone—the payer, provider, and patient.

Armed with this knowledge, health care organizations can better ensure VBC patient incentives are aligned and encourage patients to take a front seat in their health care journey and contribute to their own health outcomes in a positive way. Broadly speaking, based on the data of successful end-to-end VBC programs, the best way to start is to pick a cohort of a patient population and target the rollout of specific programs and measures.

Ajay Moody | Image credit: GCI Health

There are several actions health organizations—from providers to payers to non-traditional health organizations—can take to address this challenge.

1. Make Patients the Chief Decision Makers of their Health Care.Patients want to know upfront how much their care will cost and find a clinician whose care philosophy aligns with their health goals. Providing patients with the information that matters to them empowers them to make informed decisions about their health care. Take a first-time mother for example. What if she could evaluate and choose an OB/GYN provider based on the outcomes of patients with similar health histories and risk profiles and the average “all-in” cost incurred by other patients?
2. Design Digital Experiences to Encourage the “Right” Decisions: Today more than ever patients are using digital platforms as their “front door” to health care. Organizations need to design digital experiences that guide patients to the most appropriate care for their needs. Building upon our example of provider selection, what if a patient/provider matching tool could assess patient characteristics such as health status, insurer, location, care goals, and level of risk to recommend the OB/GYN with the highest likelihood of positive outcomes for that patient—both clinical and financial.
3. Create Financial Incentives: Identify opportunities to demonstrate the financial impact of patients’ health care decisions. Explore opportunities to lower patient out-of-pocket costs as savings are achieved through VBC programs and patient engagement. What if maternity patients could earn ‘credits’ towards their upcoming services by engaging in activities that reduce their risk for negative outcomes like gestational diabetes and preeclampsia—such as regular exercise, medication, and supplement adherence, or healthy eating.

A key element of VBC is the value brought to patients—and that’s part of what has been missing from current programs. Understanding which outcomes matter the most to patients and how they differ by individual allows VBC contracts to incent the most applicable actions and ensure insurance plan products reflect patient needs. By focusing on these areas and refreshing their strategies, health organizations can better integrate patients into the VBC framework, enhancing both patient satisfaction and health outcomes.

Accenture’s Florence Murabito and Lydia Trogdon also contributed to this article.