Contributor: The Complexity Concern in Value-Based Care

Over the last 10 years, we’ve seen a rise in value-based care (VBC) programs. Although some have shown promise in enhancing quality or reducing costs, none have achieved comprehensive scale across payers, providers, and patients, nor have they been integrated across different care pathways. There's a compelling opportunity to expand the benefits of these programs to a wider patient population. In the first article of this series, we identified 4 main challenges that health care organizations need to tackle 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 complexity concern.

Ajay Mody | Image Credit: GCI Health

Providers find VBC programs complex, and for good reason. Without the right tools, any task can seem complicated. To create a successful VBC program that improves patient access, experience, and outcomes, we need to strategically invest in and design processes that give care teams insights into their patient populations.

But foundational capabilities for VBC, such as performance reporting tools, provider engagement teams, care coordination, population health management, and utilization management tools must work together seamlessly. This integration can streamline patient management and reduce unnecessary administrative burdens. Data management and interoperability are also crucial for VBC transformation, ensuring that provider and patient information is accurate and accessible.

Technology is key to this transformation. That is why the health care industry is increasingly investing in new technologies, particularly across the AI spectrum, to boost efficiency. Continued investment in AI-powered tools can save health care providers valuable time, allowing them to focus on patient interactions and clinical decision-making. This, in turn, can improve patient population management and drive successful outcomes.

However, although population health tools can provide valuable insights into care gaps, utilization, and other key metrics, some providers lack the capital and expertise to implement them. Large health systems may have more resources but face additional VBC barriers, such as prohibitive workflows, governance issues, and team culture.

Asher Perzigian | Image Credit: GCI Health

Mature VBC provider groups prioritize provider enablement as a core tenet of their operating model and strategy. They focus on both technology infrastructure and physician training to effectively manage their patient populations.

To simplify VBC, we should focus on 3 key areas:

1. Shifting the whole organization toward value: As organizations have tried VBC, many have approached it as a ‘bolt on’ capability rather than a fundamental shift in operations. This has made it difficult to scale value across the organization or the patients they serve. To simplify VBC and achieve tangible benefits, organizations will need to shift the full organization toward value. This means examining the existing organizational structure, culture, and training practices, as well as planning for a roadmap toward value—and likely, risk.
2. Changing payer/provider partnerships to promote investment: Too often the complexity of VBC also increases the costs of delivering care—particularly when population management activities are duplicated across payer and provider. To simplify VBC and drive down costs, payers and providers need to approach partnerships in new ways. Payers and providers need to look beyond the typical annual contracting cycle to enable long-term investment in the care delivery infrastructure and care management capabilities that will drive higher-quality care at lower costs.
3. Enabling VBC with AI tools: Enabling clinicians with data and technology infrastructure facilitates outcomes-focused care delivery. Investing in tools like generative AI can help clinicians access information across data sources, allowing them to spend less time on administrative tasks and more time focused on clinical decision-making. For example, when patients send information to the office before an appointment, these tools can automatically identify and raise key information to the provider in advance of the appointment, calling out care gaps or other VBC measures that could otherwise be time-intensive for the clinician to discover and document.

These efforts are a good start but will not work without standardization. VBC programs need consistency to meet quality goals, but currently, they vary a lot. Using a framework for contracting can help standardize VBC. Simplifying contracts or educating providers more can reduce complexity and build successful VBC models. Both payers and providers should be aware of the extra burdens that complexity in VBC can add. By investing in the right technology, encouraging continuous learning, and embracing standardization, we can overcome current complexities.

This is the final article in our series on value-based care. The path to successful value-based care is clear but needs everyone's effort: payers, providers, and patients. As we move forward, the industry needs to prioritize collaboration and innovation to unlock the full potential of VBC. By scaling VBC programs, we will improve health outcomes and make health care more accessible and efficient for everyone. The opportunity is here, and together, we can transform health care for the better.

Accenture’s Florence Murabito also contributed to this article.