The healthcare industry is making the push toward greater adoption of value-based care, yet it’s not a secret that progress has been slow-moving.
With that backdrop, UnitedHealth Group has released its latest “A Path Forward” report, which is a biennial look at progress in the shift to value. The paper includes dozens of policy recommendations the team believes can accelerate that transformation.
Wyatt Decker, M.D., UnitedHealth Group executive vice president and chief physician who’s leading the charge at the company on value-based care and innovation, told Fierce Healthcare in an interview that the U.S. healthcare system is extremely effective at addressing crises, complex patient conditions and end-stage needs. But it’s in prevention where “we really fall down,” he said.
“We don’t, by and large, have a system that focuses on keeping people healthy and well,” Decker said. “Most people wonder why their physician or their assistants don’t reach out when it’s time to get a screening and why they have so much trouble scheduling appointments, finding doctors, and, of course, figuring out how much it’s all going to cost.”
“And that’s really symptomatic of the structure of the U.S. healthcare system, which is mostly fee for service,” he said.
The report’s recommendations address a range of challenges hindering value-based care, access and patient experience, UnitedHealth said. For example, it suggests that regulators update payment models under the Medicare Access and CHIP Reauthorization Act to assist physicians in building the infrastructure necessary for value-based models.
Decker said UHG has had hundreds, if not thousands, of conversations with physicians about what’s preventing them from embracing value-based care, and those discussion boil down to three key areas of concern.
For one, value-based models represent a significant cultural shift for physicians who are used to trying to squeeze in as many patients as possible. Instead, value-based care tasks them with building care teams that can monitor individual needs and identify population and patient concerns as early as possible.
“It’s a proactive model that requires, honestly, a mind shift,” Decker said. “Now, most clinicians are actually quite welcoming of this, as long as they have the tools to do it well.”
Which leads to the second challenge: building a team. To make value-based care work, they need to establish a team-based model that brings together the people who can effectively track the necessary data.
Finally, gathering effective population health data requires technology. Decker offered an example in which a patient who visited the emergency room is set to be admitted to the hospital. With the right technology in place, their care team can be notified and offer support in the ER.
This intervention, he said, could avoid an unnecessary hospital admission.
“Culture, people and having the right technology, data feeds, clinical exchange of information are really the critical ingredients for a successful transition to value-based care,” Decker said.
The report highlights Medicare Advantage (MA), which has been touted by the industry as an example of value-based care at work. It recommends that policymakers “promote a stable Medicare Advantage payment environment” that allows plans to adapt to cost increases and utilization spikes.
It also suggests that regulators require MA plans to provide supplemental benefits options that can stabilize revenue for rural providers and ensure access to care in rural areas. It also urges for protections to home care models offered by Medicare Advantage plans.
Decker said MA represents a “wonderful example of a public-private partnership” for value-based care.
In addition, the report includes multiple recommendations around health equity. It suggests continuing to integrate behavioral health needs into primary care settings and ensuring that state Medicaid programs have flexibility to adapt.
It also recommends making investments in data on disparities and social needs that can make it easier to identify challenges and improve equity.
Decker said the push for value-based care is “a long road,” but it’s critical to making the healthcare system work better for everyone.
“I think there’s a need for continued research to validate both the clinical models and the cost models, but it’s unquestionably the right direction of travel,” he said.