Health care is expensive.
And with the payment models currently in place, it’s not going to get any cheaper. In fact, health care analysts are expecting the annual cost per employee to reach $15,000. That’s enough to make any CEO spit out their coffee, no matter their business size.
But there’s hope on the horizon. A new approach to managing patient care and reimbursement—called value-based care—could be the key to making health care more affordable and more effective. Even better, your corporate wellness platform is already laying the groundwork for value-based care, shortening your runway to better health care and more manageable costs.
To examine the possibilities, we spoke with Lili Brillstein, MPH, a nationally recognized expert in health care reimbursement models with a specialty in value-based care. Before we dive into the “how” and “why,” let’s start with a quick tutorial on health care payment models.
Understanding Health Care Payment Models: Fee-For-Service Versus Value-Based Care
Most health care plans are set up to pay for units of service delivered by a single doctor.
The model goes like this: a doctor examines a patient—they’re paid a fee. They perform a procedure—another fee. And so on. Each service the doctor provides corresponds to a payment. Not surprisingly, this payment model is referred to as fee-for-service (FFS).
Seems straightforward, right?
The problem is, the FFS model has essentially become “health care in a vacuum,” because it takes the patient and their overall health outcomes out of the payment equation.
Think about a patient who has a chronic illness with multiple comorbidities (they have other conditions that make treatment more complicated). That patient has to see several doctors to treat each of their conditions. With an FFS model, each of those doctors is paid and incentivized to focus on the condition they’ve been trained to treat—usually without talking to any of the patient’s other doctors.
– Lili Brillstein
So, a doctor who treats one condition gets paid regardless of the impact that treatment had on the other conditions (or on the overall wellness of the patient). The lack of coordination leaves patients feeling like they need several medical degrees just to manage their own care.
Enter value-based care.
Value-Based Care Is Patient-Centric
Value-based care takes a totally different approach to health care payments by incentivizing outcomes—what will make this patient better, healthier, and more satisfied with their overall care?
With this model, patients aren’t responsible for spinning all the plates in their treatment plan. They just have to follow guidelines and take the prescribed steps to either prevent illness or treat their condition(s).
– Lili Brillstein
Value-Based Care Is Team-Focused
Value-based care relies on coordination, collaboration and teamwork. In fact, this model both rewards and penalizes doctors based on how efficiently and effectively they work together to deliver quality care.
In an ideal setting, multidisciplinary teams of doctors develop coordinated treatment plans that take into account how one treatment will impact the rest. And every doctor involved with that treatment plan is held accountable for the outcome.
Value-Based Care Is Proactive and Preventive
Value-based care is also designed to prevent people from becoming patients in the first place, focusing on increasing access to preventive care.
– Lili Brillstein
With VBC models, diagnosis and procedure data is combined with clinical notes and patient feedback to facilitate predictive modeling. Basically, it helps health plans, employers, and industry analysts understand the health habits and risk factors that lead to chronic disease. This lets them pinpoint the types of proactive services that can prevent illness or the need for expensive treatments.
And that preventive, individual-focused care is exactly where your corporate wellness program can shine.
How Value-Based Care and Wellness Program Synergy Can Reduce Costs
A thoughtfully designed corporate wellness program looks at employee health from a value-based care approach, with the program designed around employees’ unique needs and goals in a way that delivers better health outcomes.
By coordinating all the various program offerings—biometric screenings, disease-specific programming and wellness challenges—companies can create the best environment for a healthier, happier workforce.
They can also reduce health care costs. How? By way of data.
Corporate Wellness Platforms Can Serve as a Health Care Data Aggregator
Using the FFS model, when your employees visit each doctor for care, they may have to repeat many of the same tests, scans and other diagnostic services. And while there are electronic health record (EHR) apps that track appointments and test results, the information is still static, and doesn’t include what they do and home and work to prevent or treat illness.
Not only is this frustrating for the patient, it’s expensive for the employer and leaves the provider without important information that could potentially change how they deliver treatment.
– Lili Brillstein
A corporate wellness program can be a one-stop shop for employees to empower themselves with their own health care information—biometrics, test results, physical activity, daily nutrition, etc.—so they can streamline and optimize their care … and their health care costs.
More Data, More Efficient Care, Lower Costs
A common complaint about FFS is that it puts short-term costs ahead of care (and long-term costs).
– Lili Brillstein
The great thing is that your corporate wellness program can contribute to—and benefit from—this data. It can help you design a corporate wellness program that is closely aligned with your employees’ unique health needs, no matter how complex they are. And it can help providers gain a much clearer picture of their patients’ health, resulting in care that’s appropriate and effective.
How Your Corporate Wellness Platform Can Optimize Value-Based Care
Before you get too excited, understand that value-based care is still emerging—there are many more iterations to come that will shape how this model actually plays out.
That being said, there are ways that your corporate wellness platform and program can be set up to make value-based care more effective as it continues to evolve.
Offer Single-Site Health Care Programs
You can’t make doctors work together, but you can make it easier for them to collaborate. For example, look at your employee population. Some or all of them are back to working in the office, some may be working from home, and some may be doing both.
Think about how much easier it would be for employees to access preventive health care and treatment if those services were offered in one place. By hosting health care services on-site or at satellite sites, you can create a collaborative environment and encourage employees to be proactive about their health. Basically, you’re taking away the obstacles to healthy behaviors and outcomes.
Recommend a Community of Specialists
What if you were to help develop a network of doctors—a “medical neighborhood” of sorts—who already practice the collaboration, coordination, and communication that is at the heart of value-based care?
You could then integrate that network into your corporate wellness platform, so employees have an easily accessible list of options to contact to schedule a visit. (And your benefits administrators will be able to process claims more quickly: They just have to validate with the network on record.)
Fill the Gap in Covered Benefits
When we think about preventive care—which is what corporate wellness is about—there are nontraditional services that could be built into a value-based care model that would never have been covered by FFS.
The services your wellness program can offer help employees access care and make them healthier.
Take, for example, covering the cost of an Uber ride to get to the doctor’s office or gym. It’s not medical, it’s definitely not covered by insurance, but it may be the only way your employee can get to their doctor. And if they get to their doctor regularly, odds are good that they’ll receive effective treatment for any conditions they have, and proper preventive care for anything that is starting to cause problems.
An incentive such as Uber or Lyft vouchers could encourage employees to see their primary care provider annually, to get their yearly cancer screenings, or to regularly work out at the gym. By doing this, you’re filling gaps in their benefits and contributing to their overall health.
A Value-Based Care Mindset: Better Care, Lower Costs
When it comes to health care, everyone involved has pretty much the same goal—better outcomes and happier patients for the lowest cost. In addition, health insurers, doctors, and even employers want the ability to predict what’s needed to treat and prevent illness and how much it will cost.
Value-based care helps with that, allowing doctors to recognize the early signs of illness and conditions that take employees out of commission.
By adding the additional coordination with a corporate wellness program, the employee’s treatment plan can be incorporated into their wellness challenges, ensuring long-term health and a better outcome.
By embracing a value-based mindset and aligning your corporate wellness program to be an extension of preventive and prescribed health care, you can create the best possible environment for happy, healthy employees.
For a more in-depth understanding of how your corporate wellness program can align with the value-based care model, contact one of our team members. At WellRight, we’re here to help.
