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No More 'Low-Hanging Fruit' in Value-Based Care, Challenges Ahead for Insurers

Analysis  |  By Gregory A. Freeman  
   March 21, 2018

Even as insurers see improvements and cost savings from value-based arrangements, they have to look for new ways to implement the strategy.

The shift to a value-based healthcare system is showing positive results but the low hanging fruit has already been grabbed, says a health plan leader. Insurers and other healthcare entities will have to get creative and find more complex ways to draw value from the system.

That's the challenge facing UnitedHealthcare, which is seeing significant advances in people's health behaviors, better coordination of care among physicians and facilities, and cost savings with care providers who have implemented value-based arrangements, according to a recent report from the insurer.

Approximately $64 billion of the total annual payments UnitedHealthcare makes to care providers is tied to value-based arrangements, and the company expects that figure to rise to $75 billion by the end of 2020, says Gyasi Chisley, vice president for payment strategy at UnitedHealthcare.

"You get good results and you challenge yourself even more," he says. "We're committed to reaching that $75 billion mark but that's something that is going to be pretty hard to do because we've pretty much exhausted the low-hanging fruit. We've eaten that and seen the results, so now we're going to aim higher with partnerships with providers."

One strategy involves ensuring that physician incentives are appropriately distributed, he says.

"We want to make sure that incentives are not going only or primarily to a subset of urban physicians or physicians tied to a health system," Chisley says. "The challenge is how to take our products and incentives and proliferate them to a more rural setting or to physicians who operate in a more independent fashion. Expanding more into the rural setting will let us engage physicians that we might not otherwise reach. "

Physicians like to work with other professionals they trust, Chisley says, so UnitedHealthcare is looking for ways to incorporate not only primary care physicians but also specialists in the mix for value-based care programs.

"We want to get as many members as we can into a value-based care program and track those metrics accordingly," he says. "We can't optimize those numbers without reaching out more to their physicians, their specialists, and others who aren't involved in value-based care right now."

Real-time data

Part of UnitedHealthcare's value-based care strategy involves utilizing data in real time, Chisley says. The health plan integrates its own data with provider information to create more of a real-time snapshot of the patient experience than has previously been available.

"We want to get that current snapshot of what the member is going through so we can make sure we're designing programs and value-based care products that match not only the provider's needs but also what the member is going through," he says.

Accountable care organizations (ACO) serving employer-sponsored plan participants perform better than non-ACOs on 87% of the quality metrics tracked, the report says, with hospital admission rates that are 17% lower for ACOs serving employer-sponsored and individual plan participants compared to non-ACOs.  

"We know we're making an impact, making a dent, but we still have a long way to go to leverage everything we have in the entire enterprise," Chisley says. "That includes driving not only the results, but changing the mindset and the culture as well."

UnitedHealthcare has about 15 million people enrolled in value-based plans, and Chisley says clear patterns have begun to emerge illustrating the benefit of that enhanced care coordination. 

Providers are embracing the concept more in recent years, he says. Twenty percent of Medicare ACOs working with UnitedHealthcare are sharing a greater portion of the responsibility for patients' total care, including quality and healthcare costs, compared to a year earlier.

Some of the early adopters in the provider community are starting to see their Triple Aim goals come to fruition, Chisley says. The Triple Aim calls for providers to improve the patient experience of care (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of healthcare.

The UnitedHealthcare report cites the example of Arizona Care Network, which reduced its healthcare costs by millions of dollars within the first two years of its ACO with UnitedHealthcare. According to the report, patients requiring a hospital admission spent 25% less time in the hospital. Arizona Care Network also saw a 30% increase in the number of UnitedHealthcare patients it serves, says Chisley.

"We know there is still more opportunity to partner with providers and bring them the benefits of value-based care, so we're looking at more ways to reach out to those providers," Chisley says. "That is what is propelling us for the next several years, through 2020 and we're setting goals even into 2025."

Gregory A. Freeman is a contributing writer for HealthLeaders.

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