Payers, providers, and other healthcare industry professionals all hands in to work together to support value-based care and patient experience

The Role of Value-Based Healthcare in Patient and Member Experience

Payers are focusing more on value-based healthcare, patient experience, and what supports it, like building infrastructure and data analytics. Value-based care enables payers to more easily control costs and members to select plans that support this healthcare delivery model.

Value-based healthcare is the ideal opportunity to encourage patient experience, save costs, assess risk, and improve population health while growing in STAR ratings. This healthcare delivery method has gained industry support since its introduction in 2006, encouraging the growth of different types of healthcare payment opportunities for members, such as performance-based payments, bundles, shared savings, and capitation payments.

Understanding The Financial Role of Value-Based Healthcare

Value-based healthcare has a strong impact on the patient experience. As a result, the healthcare community has shifted focus from other care methods to value-based care. This has helped create an overall better experience for members, allowing payers to work alongside providers to improve the value of care, reduce risk, and lower overall costs.

For clarity, let’s compare two different healthcare delivery models.

Healthcare Delivery Models

Fee-for-service

Fee-for-service is a payment method of healthcare in which providers are paid for each individual service performed.

Value-Based Healthcare

Value-based healthcare is a method of healthcare that encourages providers to focus on the quality of services rather than the quantity of services provided. Healthcare providers are paid an overall sum for the care provided.

 

Value-based healthcare can translate to stronger cost controls and reduced risk for payers. Payers can reduce claims and extra expenditures by assessing the health of the larger population and utilizing this data to create more accurate risk-management profiles. “The Concentration of Physician Services Across Insurers and the Effects on Quality,” by The American Public Health Association, argues that when utilizing value-based care, healthcare professionals are more likely to provide a higher quality of care and nurture a better relationship with members. 

While payers still assume some risk, they can reduce their overall exposureby creating value-based contracts that outline: 

  • Possible outcomes of healthcare goods and services for a specific condition and population.
  • Measurements of clinical outcomes from real-world scenarios regarding data.
  • Formulas for prices on services and goods provided.

Value-Based Healthcare Positively Impacts STAR Ratings

The Centers for Medicare & Medicaid Services (CMS) STAR Rating comprises approximately 45 quality measures. These ratings are important for Medicare members looking to determine which payers offer the highest quality Medicare health and drug plans. The higher-rated plans encourage member retention and application submissions.

Beyond the benefit of better member acquisition and attraction, the CMS provides financial incentives to increase STAR rating. Higher reimbursement and annual bonus payments are paid out to plans with a STAR rating of 4 or higher. These ratings play a critical role in the payers' financial future. CMS provides a warning for plans receiving under a 3 for three years in a row.

Value-based healthcare models encourage higher STAR ratings because they focus on care quality. Value-based care models optimize the quality of care, increasing the rating of each quality measure that CMS looks for in the STAR Rating audits.

Promoting Value-Based Healthcare For Patient Experience With Your Digital Ecosystem

Digital transformation and interoperability help enable value-based arrangements in healthcare and improve the patient experience by providing payers with larger data sets for risk assessment, more extensive networks for member care, and more. Here are a few ways to optimize your digital architecture to develop value-based healthcare.

1. Working With Provider Networks

Directly working with provider networks can help encourage value-based healthcare because payers can evaluate the providers' quality of care before allowing members to use that care provider. This guarantees that all plan members receive value-based care—patient experience improves. 

This also allows payers to negotiate payments with providers to ensure their members receive the best costs for services. 

2. Preventative Care Reminders

Improving member and patient communication goes hand-in-hand with value-based arrangements. Contacting members on past due vaccines or screenings helps improve outcomes and encourages individuals to take ownership of their own health. Members' awareness of their health needs can prevent severe health issues and costs from said incidents.  

3. Choosing The Right Network Provider

When payers and providers work together, the efficiency of care can increase drastically. By selecting the right network providers, payers can be completely transparent with their members on what they will receive. This transparency encourages the relationship between payer and member, increasing customer satisfaction. 

4. Examine Member Satisfaction Data

Member satisfaction data is important for determining internal work processes and future plans for growth. By analyzing this data, payers are able to view important patterns in their members' user experience and needs. Important data to evaluate includes:

  • Are members finding the right information that they need from us?
    • Is it easy for members to select plans?
    • Is it easy for members to get a referral?
    • Is it easy for members to make an appointment?
  • Are providers within the network providing the care that is expected?

Tech Solutions For Member Satisfaction

Salesforce

Salesforce is a Customer Relationship Management (CRM) platform that provides teams with a shared view of every member allowing automated workflows, easy integrations, and personalized tools for analytics.

Snowflake

Snowflake Cloud Data Platform helps payers derive all insights from all their data by all their members. This integrated platform is the only data warehouse built for any cloud.

Tealium

Tealium offers a Customer Data Platform that helps payers build out a 360-degree view of members with customer data profiles, analytics, and personalized customer experiences.

Improve Your Members Overall Experience With Concord

CMS STAR ratings have proven to be a vital aspect of payers' financial performance, and the main driver for high-rated plans is value-based healthcare—customer experience is crucial. There are integral parts of value-based care that can't all be handled by a single software without a plan set in place. Assessing member analytics, setting up preventative care reminders, working with provider networks, and selecting the correct networks to work with are only a handful of the many tasks needing navigation for value-based care to prosper. To help, consider speaking to a specialty tech consultant that has valuable experience and expertise that can be applied to your individual circumstances and members' needs.

Getting Started

Concord USA is a consultancy that combines technology and industry depth with a get-it-done culture to enable resiliency, efficiency, and innovation. Whether you are trying to improve customer satisfaction, data strategies, security, or other technological issues, Concord can help. 

Contact us today to learn more about the role of value-based healthcare, patient experience, our Technology Integration Services, and how we can help your business thrive.

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