July 20198In keeping with its nature as a scientific discipline, medical knowledge and its health care applications advance slowly and not always linearly. New diagnostic tools, new treatments, new ways of delivering care all are carefully studied, tested, and refined before becoming standard.Today, however, health care is experiencing more rapid change, even disruption. From Artificial Intelligence and gene sequencing to crowd-sourced self-care and new care payment models, health care is changing rapidly. We have an opportunity to guide those changes to achieve a healthier population, better care experiences, and controlled costs.Significant hurdles exist: an aging and rapidly growing senior population with a high prevalence of costly unhealthy behaviors that strains our current system. Three in every four seniors are living with multiple chronic conditions, the results of health and lifestyle decisions. Reversing the impact of these conditions, accounting for 71 percent of health care spending, must go beyond more technology and clinical services.YOU CAN'T HAVE ONE WITHOUT THE OTHER: Value and TechThe time has come to review, analyze, and accept new payment models that advance individual patient health outcomes to address shortcomings in our present system.A History of ConflictAt present, physicians, clinicians, and other care professionals who operate in a fee-for-service model are reimbursed for their services, not for patient health outcomes. Fee-for-service physicians need to convince health plans to pay them for the services they deliver. The relationship between physicians and health plans is generally adversarial. This is not an immutable state.Value-based care is based on alignment between health plans and physicians. Physicians, clinicians, or hospitals manage the entire health of the population and use evidence-based protocols to deliver personalized care. The physician groups are encouraged to spend health care dollars (and their time) in ways that maximize patient health.Take the example of a patient living with diabetes. In a value-based model, the health plan and the physician are incentivized to improve health outcomes, not just deliver another service. The physician practice succeeds financially when its patients achieve their health care goals. This type of care is not a passing fad--it is what clinicians and patients deserve and are experiencing. At Humana, 1.65 million individual Medicare Advantage members cared for by physicians and other care providers in a value relationship experienced, on average, fewer hospital inpatient admissions and ER visits.Where the Data ResideValue-based payments are helping us evolve from a model focused on episodic care. However, the new payment model requires data to fulfill its potential. Data, analyzed to turn numbers into knowledge and knowledge into actionable insights, must be integrated into work flows so the care team can identify Roy A. Beveridge, M.D., Chief Medical Officer, Humana, and Thomas J. Van Gilder, M.D., Chief Medical Officer, Transcend InsightsIn My OpinionBy
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