Healthcare spending makes up 18% of the GDP. The country with the second-highest percentage of GDP spent on healthcare is Switzerland at 12%. Though the rate of the annual increase in the amount spent on healthcare has dropped from double digits over a decade ago to 4% last year, it is still higher than the inflation rate. This level of growth is unsustainable and directly impacts other areas of the economy. There are many factors that have contributed to the rising cost of healthcare, but fee-for-service reimbursement is one of the main culprits. Addressing this aspect is key to help curb the trend. That is where value-based programs come into play.
Value-based programs shift the focus from quantity to quality, prioritizing the right care at the right time over a piecemeal approach. This reveals which types of care are actually needed and ensures that the patient understands the process and communication is open among all parties participating in the patient’s care. This shift alone has provided a lot of savings. As mentioned above, the annual healthcare inflation rate has been dropping more towards standard inflation rates.
There are ways to help speed up the process of value-based integration. One of the key strategies is to remove silos from programs. Programs should be built to work together. Primary Care Physicians (PCPs) can only get so far without specialists’ assistance; conversely, any approach that is purely focused on specialists leaves prevention efforts, referral programs, medication programs, and long-term maintenance care off the table. Understanding this and making programs that complement each other instead of competing with each other will help ensure all opportunities are addressed and are actionable.
Another value-based care method is fully utilizing technology to give providers actionable data when they need it. Quite often data lags well behind the point of care. EHRs are not easily connected to each other or other important systems. Claims data, by nature, are always delayed. The ideal situation would be to easily share patient data at the appropriate times. It will take a lot of work to get to this point, but waiting for this level of integration fails to take advantage of the incremental improvements that can be made today. By utilizing systems already in place to speed up access to the data, we could do wonders to help providers know when things are starting to go in a direction they might not want. An example of such a system could be a notification system through HL7 back to providers or payers sharing claims data closer to when it is processed for providers participating in value-based care programs versus in a monthly or quarterly feed. This can help care providers better manage patient care. Every participant in the healthcare system can do a better job of getting actionable data into the right hands as fast as possible.
Another key area is to use the available data to determine the best approaches to standardized and flexible care. Quality care needs to be customized to the patient’s needs that arise from specific social determinants. However, that customization does not need to be wholly unique each time. There are healthcare guidelines that can be utilized to better ensure the right care is being performed at the right time. Studies are being conducted to determine how best to treat patients with various conditions and diseases. Their findings can become the framework to then customize with the additional data elements that are known. Tests can be done to determine the genetics of a tumor to help narrow down the right treatment approach for cancer. Understanding the patient’s transportation needs can help determine the best approach for post-acute care after a surgery. The main care path is the same but tweaked to address each specific patient’s needs. This provides the benefit of having an established plan of care in place and a mutual understanding of the roles both upstream and downstream from that moment but can also be flexible enough to make sure that the specific needs of the patient are taken into consideration. As databases of de-identified patient data become more prevalent, more studies on what care works best in what situation will lead to more standardization of care. This in turn can lead to much greater efficiency and quality of care. Allowing for the other necessary data elements that are specific to that patient to be considered will need to be included to make sure that the care paths are always appropriate.
There are many other opportunities to bend the healthcare curve, but understanding the massively important roles of data and communication is vital. Shifting the focus to quality can only occur if these two aspects are put front and center. Those who provide care are the most important part of healthcare both in terms of treatment, but also for the patients themselves. Patient privacy is always important; often the barriers to data sharing are not due to the patient’s choice but by other arbitrary factors. Making sure that healthcare providers have access to the information they need to truly support their patients will massively improve the quality of care. With that, the curve can dramatically be bent.
U.S. national health expenditure as percent of GDP from 1960 to 2020
How does health spending in the U.S. compare to other countries?
How Top Accountable Care Organizations Save Year After Year
A 5-Point Model for Value-Based Health Care
1% Steps for Health Care Reform