SDOH, tech key to advancing value-based care, says UHG

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While progress toward the adoption of value-based care has been a slow lumber, the healthcare industry is still pushing toward that transition, with UnitedHealth Group weighing in on how best to accelerate that transformation.

In its latest "A Path Forward" report, UHG said that as of 2023, about 60% of UnitedHealthcare members are served by physicians under value-based arrangements, an increase from previous years, which the insurer said reflects its efforts to move away from fee-for-service models.

According to the report, value-based arrangements have resulted in 12% lower healthcare costs and a 26% reduction in hospital admissions for patients under these contracts. Moreover, outcomes such as improved chronic disease management and better preventive care were cited by UHG as evidence of the success of this model.

Yet there are several critical components that are key for advancing, and accelerating, the shift to value-based care, UHG said.

WHAT'S THE IMPACT

Sophisticated analytics tools are crucial for identifying high-risk patients, managing chronic conditions, and ensuring that providers have real-time access to actionable data, the report found.

It also emphasized the need for strong partnerships between payers and providers to create aligned incentives. UnitedHealth's Optum division, which integrates healthcare services and technology, plays a significant role in this aspect by offering providers the infrastructure needed to transition to value-based models, UHG said.

One of the most important elements of UnitedHealth's strategy has been its focus on addressing social determinants of health, which includes factors such as housing, nutrition and transportation. Authors contend that addressing these non-medical factors can have a profound impact on overall health outcomes, particularly in underserved populations.

Another key component of UnitedHealth's strategy has been the promotion of preventive care and the effective management of chronic diseases. The company said it has invested in programs that provide incentives for primary care visits and screenings, aiming to catch health issues early and manage chronic conditions before they escalate.

Despite all that, challenges persist. One major hurdle is that many providers are still entrenched in fee-for-service models, which can be difficult to move away from without sufficient financial incentives or support, authors said. And smaller practices may lack the technology infrastructure needed to succeed in a value-based environment.

There's been movement at the policy level in recent years, with the Centers for Medicare and Medicaid Services pushing initiatives that promote value-based arrangements. Programs such as the Medicare Shared Savings Program and various Accountable Care Organization (ACO) models have incentivized providers to adopt value-based care frameworks.

But the report stressed the importance of continued innovation and collaboration across the healthcare system to further the adoption of value-based care. This includes working closely with policymakers to ensure that reimbursement structures align with the goals of value-based care, and that providers have access to the resources they need to make the transition.

THE LARGER TREND

A 2022 report from the Medical Group Management Association found that value-based care still only accounts for a small portion of medical revenue in most specialties.

Data from the survey found that revenue from value-based contracts accounted for 6.74% of total medical revenue in primary care specialties, 5.54% in surgical specialties and 14.74% in nonsurgical specialties.

Across all practices, the median revenue amount from value-based contracts was $30,922 per provider.

A JAMA Network study published this year found that value-based Medicare Advantage models see better outcomes and better efficiency for patients, both in general and across specific metrics such as avoidable emergency department visits and readmissions.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.