As an employer, you have a choice: You can focus on sickness management, or you can focus on prevention.
The fee-for-service model emphasizes sick care — caring for patients after they become ill. The value-based model emphasizes health care — specifically, preventive health care. The goal? Keeping patients well right from the beginning. Even without considering its benefits for your employees, this approach to care makes sense. After all, healthy patients cost less — for insurers and for you. Investing in preventive health care now means avoiding more expensive treatment later on.
Individuals in a value-based health plan generally receive more preventive care and are more likely to stick to their medication regimens and disease management plans than patients in fee-for-service plans. For an example of how this works in practice, consider TriHealth and Anthem’s value-based health care partnership in Ohio. It led to increased preventive care, including diabetes testing, and lowered costs for employers — both direct health care costs and those related to presenteeism and absenteeism.
Here’s a look at how value-based care can help translate preventive care into savings for you and your employees.
Unpacking Preventive Health Care
When you think about prevention, what probably comes to mind is primary or secondary prevention, though chances are you don’t call it that. Primary prevention — such as vaccines — works to prevent disease or injury before it occurs. Secondary prevention focuses on reducing the impact of an existing disease or injury. Common screenings like mammograms and prostate exams fall into this category, since they aim to detect disease in its earliest stages, when it’s less difficult (and less costly) to treat.
But there’s another layer. Just as important as controlling costs and supporting employee health is tertiary prevention, which concentrates on ensuring those who already have a condition are as healthy as possible. This approach centers on improving functionality and preventing complications. Tertiary prevention can come in the form of blood pressure management, remote monitoring of patients with chronic conditions or even rehab — anything that improves life for those already affected by an injury or condition.
Keep the healthy in good health, identify and mitigate risk and improve the wellness of those in poor health: That’s the essence of preventive care, and it’s a win-win for employers and employees. It doesn’t solve any problems on its own, though. To make it happen, you need data.
The Role of Data in Prevention
In a fragmented fee-for-service system, physicians lack access to all of the information necessary to deliver care. They often take a piecemeal approach, treating the symptom instead of the patient.
In value-based care, doctors are paid based on how effective their care is — in other words, how much value it brings. This system encourages them to coordinate on patients’ care and share data with each other. In fact, coordinated care is one of the primary benefits of value-based care. Value-based approaches to care are most successful when doctors have access not only to their own data but to patient data across the continuum of care, from labs to specialists. Because information isn’t siloed, clinicians have a better view of the whole patient.
Data also comes into play when providers and insurers go to identify risk factors and predict hospital readmissions for patients with chronic diseases. Data-driven predictive modeling allows physicians to stratify patients by risk and customize care to mitigate that risk. The more data, the more precise the predictions. Anthem, for instance, has an integrated data “warehouse” that includes information about members drawn from claims data, electronic records and other key data sets. All of that information can be used to identify which patients are at risk for stroke, diabetes or something else entirely.
Sophisticated data modeling and risk stratification mean better preventive care for your employees. It’s cheaper and less stressful to prevent an illness — especially a chronic illness — than it is to treat it, just like it’s easier and less expensive to manage a chronic condition than to deal with complications in the hospital. This time, the wisest decision is also the easiest: Focus on health.