Putting patients at the center of care

Health systems are increasingly moving toward value-based care, a model that prioritizes early intervention, rewards high-quality care, delivers better outcomes and drives lower costs. Caitlin Zulla, Optum Health East CEO, discussed what’s needed for a successful transition to value-based care at the Wharton School of the University of Pennsylvania’s Health Care Business Conference in Philadelphia earlier this year. Optum Health, part of UnitedHealth Group, provides patient-centered care to communities nationwide serving 103 million unique customers.

The dominant health care delivery model in the U.S., known as fee-for-service, places more value on the number of patients a provider can see on any given day, rather than on the quality of care provided. Under fee-for-service, care is often fragmented and difficult to navigate for consumers, with little incentive for care coordination.

To better meet patients’ needs and to improve care delivery, health systems are transitioning to a model called value-based care (VBC). VBC recognizes patients want a simpler health care experience – one that’s accessible, affordable and available at their convenience, whenever and wherever they need it. It also recognizes that clinicians want the time, tools and insights not only to care for patients when they are sick, but also to maintain their long-term health and well-being.

Value-based care is designed to meet those needs by:

• Putting primary care at the center.
• Enabling clinicians to develop personalized care plans using real-time data and evidence-based clinical insights to anticipate what their patients might need.
• Rewarding providers for keeping people healthy.

In her talk, Zulla discussed ways health systems and providers can accelerate the transition to value-based care. She acknowledged the shift isn’t as easy as flipping a switch; it’s more of a journey and one that has been slow to gain traction because of its complexity.

Challenges

Value-based care models include varying degrees of financial risk assumed by providers. Transitioning to any value-based model requires experience, investments, and comprehensive care services to ensure patients receive high-quality care.

Challenges include:

• The need to educate physicians about the various models and benefits of value-based care.  
• The need for significant investments in technology, data, and clinical capabilities.  
• The need to equip providers with real-time patient data to effectively engage patients, proactively deploy the right intervention, and measure and report quality and outcomes.

The journey to better support clinicians and patients

Zulla said health systems and provider practices looking to serve patients through a value-based care model need to focus on making investments in three key areas:

Integrated clinical model with aligned incentives

• Patients should have access to a full spectrum of services — behavioral, pharmacy, surgical or primary care—and providers should meet patients where they need care – in the clinic, at home or virtually.
  • Optum’s integrated care delivery capabilities are uniquely positioned to help people and providers transition to value-based care.
• There should be alignment among the supporting systems, such as electronic medical records (EMRs), to make the experience more seamless for both providers and patients.

Patient care coordination

• Patients should receive the right care where and when they need it – whether that’s in the clinic or in the home and with the right provider. This means leveraging other staff, including care coordinators, to prevent and close gaps in care and address social determinants of health.
  • Care coordinators help manage a patient’s medications, arrange transportation to medical appointments and connect them to behavioral health services – all essential to support the care provided by primary care physicians and advanced practice clinicians.

Advanced data and technology

• Clinicians need evidence-based clinical decision support tools at the point of care, and the ability to leverage new technologies – like ambient voice recognition – to lessen administrative burden.
• Clinical support tools help providers conduct patient engagement and outreach, allowing them to grow their capacity to serve more patients and spend more time with each.
• A more simplified administrative process can make both the provider and consumer experience better.
• Leveraging data-driven insights and expanding EMR capabilities can better address health concerns before they become issues.
  

Zulla emphasized that the transition to value-based care can be challenging, but it’s the path to achieving a high-performing health care system – one that benefits both patients and clinicians.

“It’s care designed to keep people healthier over the course of their lifetimes,” Zulla said.