Xerox Survey - Payer / Provider Perspectives

As we check into healthcare reform that has moved away from a “fee-for-service” model and working toward a “pay-for-performance, value-based care model,” there have been many discussions that often question if we are succeeding and achieving a successful model.

We know the implications are tremendous for healthcare delivery systems starting with providing additional technology support. and looking ahead to the MACRA preparation.

I have heard it over and over…“Our data is money.” Physicians, providers and payers all need better data insights in order to improve clinical, financial, and operational outcomes and this part of the value-based medicine model.

The question remains: Is this model a success as originally proposed? The reviews and critics are slow to announce a verdict and from what I’ve seen, the jury has the greatest challenge – how to measure this change.

We know the big areas that incur the most cost are:

  • Analytics to aggregate and segment population data
  • Staffing to support the additional measure and help predict the risk along with coordinate care

We are working toward bringing together practices’ fragmented systems (in which every local provider offers a full range of services) and services for particular medical conditions concentrated in health-delivery organizations and in the right locations to deliver high-value care. The challenges are in proactively managing patient relationships to achieve this, making sure technology is advanced, and making sure reimbursement is clearly reflecting the changes occurring.  Initiatives include Accountable Care Organizations, Patient Centered Medical Homes, Bundled Payment, and Clinical Transformation.

Some interesting observations captured in a survey reflect the challenges we still have:

Based on all the studies and the changes providers have made, it is still too early to measure the cost of this immense change and declare it a successful path forward. Each environment is unique. We know we couldn’t remain with the fee-for-service model, and this alternative provides an immense capability to provide support, especially for chronic disease conditions.

I can say I have seen examples of savings based on using analytics and other combined solutions for hospital and health systems. These, of course, were fueled by creating a model that equates to success in a value-based medicine world.

Lastly, remember to plan for the MACRA (Medicare Access and CHIP Reauthorization Act of 2015). This was passed last year in respect to treating Medicare patients, and details are still being finalized.