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Value-Based Care: Understanding Price vs. Value in Healthcare

By October 15, 2018Health Insurance
Health professionals talking

As with any big decision or large investment you make, one critical component should be understanding the difference between the price you’ll pay and the value you’ll receive.

When it comes to your organization’s healthcare benefits, likely your second largest expense after payroll, knowing what you are getting for your money is more complex than ever before. How do you balance the fiscal health of your business with the need to provide your employees access to the best healthcare? Now, more than ever, employers, consultants, health plans and providers are working together to address this challenging question.

The pursuit of greater value in healthcare is influenced by a number of factors. We are in the midst of a fundamental shift in the way care is paid for and delivered, and we can see it in our data. We’ll review a few of the factors driving this change, as well as highlight the increased flexibility and enhanced decision making offered by data-driven network solutions. Together, these efforts are intended to improve healthcare quality, minimize costs and inform your choices.

A shift from volume to value. Across the country, insurers and providers are working to move away from traditional models of fee-for-service care or volume-based contracts and toward value-based arrangements. In other words, as the model shifts, doctors and hospitals are paid based on their ability to help your employees get healthy and stay healthy through better coordinated care. Essentially, providers are more accountable for delivering effective and efficient care — the core of the value-based care concept. We believe that evolving reimbursement from volume to value is a more sustainable model for the future of healthcare.

Creating higher-performing healthcare. The evolution towards payment for quality and maximized value is dependent on data, and we live in an era of unparalleled access to data. Forward-thinking health plans are leveraging data and analytics to educate doctors and hospitals about their own performance in comparison to successful practice trends, enabling them to deliver the right care at the right time and place. In cooperation with providers, thanks to the data, insurers are able to ask the right questions to determine key metrics to measure health outcomes. Is care prompt and cost-effective? Are unnecessary visits, treatments or tests avoided? Do patients remain healthy? And most importantly, are patients satisfied? Quality metrics support the delivery of care for your employees.

The engaged employee. Few things are more empowering than the ability to take charge of your own health. By providing transparency on provider cost and quality and incentivizing employees to choose higher-performing providers, your employees go from being patients to partners in their own healthcare. Using a variety of informational engagement tools, employees have more control over their healthcare decisions because they have more data, better informed choices and greater awareness of how healthcare works. Strategically designed benefits that engage your employees can help them save money and help your organization save money, as well.

Employees benefit from better care, improved outcomes and lower healthcare costs. Employers can benefit from lower total healthcare cost and increased employee time at work. By evolving the way doctors and hospitals are paid, giving them the tools and data they need, and by engaging and empowering your employees, we can rein in costs for everyone.

This is the promise of close collaboration between all of us — health plans, providers and employers — to ensure every one of your employees receives healthcare value at a lower cost. This is the future of sustainable healthcare in the U.S., and this is how value-based care can work for you.

This blog was originally published on Blue Cross Blue Shield.


Jennifer Atkins

Jennifer Atkins is vice president, network solutions for the Blue Cross Blue Shield Association (BCBSA), a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield (BCBS) companies. The BCBS System is the nation’s largest health insurer, covering one-in-three of all Americans. Atkins is responsible for all of BCBSA’s national network solutions, including the Blue Distinction portfolio of high-performance networks. Most recently Atkins was regional vice president of provider solutions at Anthem Blue Cross and Blue Shield in Wisconsin, with accountability for statewide provider contracting, network development and strategy. Prior to that she spent 10 years at Mercy Health, a Catholic healthcare ministry serving Ohio and Kentucky. Atkins is also committed to working with various charitable organizations; she currently serves on the board as vice president of Hope House, a nonprofit shelter and community center located on the near south side of Milwaukee. Previously, she was on the board of FOCUS / Beach House, a Toledo, Ohio organization dedicated to resolving the root causes of homelessness and on the board of the YWCA of Toledo. She has also been active in the Boy Scouts of America and the National Forensics League. Atkins earned an M.B.A. with an emphasis in finance from the University of Toledo and a bachelor’s degree in history and English from Bowling Green State University.