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Unlocking Value-Based Care's Upside

Edward Prewitt, for HealthLeaders Media, February 11, 2013

The second key ingredient of xG's recipe is hyper-focused care management. "Specially trained, embedded case managers are a powerful weapon," Steinberg told me. "I call them ‘commando RNs.' That connotes a personality that is active and takes initiative. They take charge of the most complicated patients. They're extremely valuable in improving care in a very cost-effective manner."

Population health analytics and focused case management, plus consulting to assess a healthcare system's needs, form the core of xG's offerings. "Out of the box, you can't do everything at once, so we concentrate on those things where Geisinger has something particularly valuable," Steinberg says.

xG's approach has already been pilot-tested at two healthcare systems in West Virginia and Maine. Geisinger brought its health data analytics expertise and systems, parachuted in commando case managers, and took over third-party administration so it could examine claims data. "The early utilization impacts are strikingly similar to what we have observed at Geisinger," Steinberg says. 

But will xG offerings provide a good ROI for healthcare systems? Maybe, says Steinberg. "It depends on where they're starting from." Primary care is a prerequisite to value-based care, and organizations lacking that base would have to make an investment.

Another aspect beyond xG's purview has to do with negotiations between provider and payer. "The key is to be in a financial arrangement where you get a cut, as opposed to giving it all to the payer," Steinberg says. In the value-based world, provider executives must ensure that they're not only delivering good value for patients but also retaining value for their own organizations.


Edward Prewitt is the Editorial Director of HealthLeaders Media.
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