Historically healthcare has been dominated by fee-for-service payment models that focused on the individual symptoms and events that surround healthcare in America. While a seemingly simple system—get sick, pay for treatment—the fee-for-service model, unfortunately, emphasizes reactive, narrow care without regard for the outcome. But the industry is changing. Value-based care is an increasingly popular model that focuses on whole person care and sees health as an all-encompassing whole with a primary focus on the outcomes obtained rather than the services rendered. Seemingly disparate, yet highly impactful, elements of someone’s life come together, including social determinants, mental and physical wellbeing, and behavioral issues to create a patient-centered focus with the goal of improved outcomes across a patient’s life. As the industry continues to move toward value-based care, the need for effective care coordination becomes readily apparent.
Over the last several years, the Federal government has encouraged the move to value-based care through legislation and program development. MIPS—Merit-based Incentive Payment System—is an initiative of MACRA focused on shifting how federally supported health programs are reimbursed. In particular, reimbursements now focus on the outcome of services offered, not the number of services. This paradigm shift in healthcare encourages collaboration among providers, community support groups, patients, and others to ensure that the best health outcomes are obtained. This shift also supports efforts to identify, understand, and proactively respond to social determinants of health before they become larger health issues and feed that data back into the healthcare ecosystem to improve and support broader, community-based healthcare efforts.
As providers, community partners, patients, and others become more involved and informed in managing and supporting healthcare, the need for greater communication, data sharing, and data security increases. Care coordination fills that gap and provides the tools and resources that enable rapid, coordinated, and educated responses to healthcare on both the individual and community level. Because information is more easily shared in a care-coordinated environment, industry professionals can more readily identify and analyze population health factors using social determinants, such as income, housing status, education, racial and gender factors, and regional characteristics all of which enable a more capable and complete approach to value-based care.
Health IT and interoperability is one potential stumbling block for some providers moving to value-based care models. While IT standards for healthcare are improving, the wide range of systems available to providers and supporting organizations creates issues for effectively sharing and communicating data within their communities. Care Coordination systems provide a measure of relief and provide a consistent, stable platform for standardizing and communicating health information.
Value-based care is expanding. Forbes recently predicted that 15% of global healthcare spending will happen in a value-based model with the United States seen as a leader in that transition. The Federal government has shown strong interest in moving to and supporting the model through legislation and modified reimbursement programs. But beyond those fundamental shifts supporting the move to value-based care, the opportunity to adjust to whole person care that focuses on the total health outcome may simply be too great of an opportunity to ignore.