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Will COVID Drive A Faster Shift to Value-Based Care?

I’ve been writing recently about my thoughts on what the COVID pandemic will mean for the future of the Health Care and Health Plans.

Obviously this year’s reporting system is going to be wild. 

But, there is also big opportunities with the rise of telehealth.

So what else?  I see a major shift to even more value based care.

Value and Risk

Value Based Care has been steadily rising, especially in government health plans like Medicare, Medicaid, and ACA.  Now, however, we’re likely to see an even sharper increase.

These contracts between health plans and providers or provider organizations can take a variety of forms, from simple capitation rates to capitation with incentives, to partial or full risk-based contracting where providers have maximum financial reward and responsibility.

Simply from a philosophical standpoint, it has always made sense to me that providers were rewarded not just for performing services, but for actually making an effective impact on maintaining and improving the health of their patients.  However, now with COVID, we are likely to see Value Based Contracting increase.

It is obvious that those with chronic conditions are more susceptible to COVID, so it would not be surprising to me to see NCQA adjusting quality measures to address more preventative care for conditions like Type-2 Diabetes.  Likewise, because Value Based Care also allows for a more cooperative health plan/provider relationship rather than a strictly Fee-for-Service relationship (which can sometimes seem more adversarial than collaborative), and because capitated revenue may be favorable in uncertain times, I also expect more providers to star looking for Value Based Contracts.

The Opportunity

It’s been said that in every problem there lies an opportunity for a solution.  This is certainly true here.  Just consider that the most vulnerable population is the one that is on Medicare.

A Medicare Advantage Health Plan that is able to demonstrate their increased ability to serve members during the pandemic through innovative collaborations with their primary care providers is going to have a significant advantage.  Ones that can confidently demonstrate their commitment to preventative care measures can excel.

In times of uncertainty, people focus on the fundamentals.  And it seems to me that more and more people are gaining a good perspective on what it means, fundamentally, to stay healthy.

Health Plans that want to stay competitive will have to adjust accordingly.

We’re happy to help,

John

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