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How Medicare Advantage Prepares Providers (and Healthcare) for the Value-Based Transition

How Medicare Advantage Prepares Providers (and Healthcare) for the Value-Based Transition

Healthcare is changing rapidly, and innovation needs to lead the charge. Nowhere is this seen more than with Medicare Advantage. These plans balance federal regulation and commercial creativity. HHS Secretary Alex Azar recently hinted at new Medicare Advantage payment plans that address the social determinants of health and rural healthcare. It is this type of willingness to consider new approaches that will accelerate the industry’s transition to value-based care.

Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance, captured this sentiment perfectly.

“Providers support Medicare Advantage because it provides an effective framework to care for our country’s growing and increasingly complex Medicare patient population. They recognize that Medicare Advantage enables care the way it should be, with patient-centered primary care, early intervention, and care coordination, particularly for those with multiple chronic conditions.”

Patient-centered primary care, early intervention, and care coordination are three components of not only an effective Medicare Advantage policy, but also of value-based care.

Here’s how.

Patient-Centered Primary Care

Healthcare consumerism is changing how care is and should be delivered. Patients want to shop for treatment the same way they’d read reviews to make informed decisions. After all, data suggests engaged, empowered patients have better health outcomes.

Patients’ relationship with their primary care provider is still the cornerstone of a patient-focused approach. What has changed are the tools the market offers: telehealth, patient portals, online scheduling. Even a few years ago, these were nice, helpful perks. However, these are no longer optional for providers who want to focus on value instead of volume.

Medicare Advantage and value-based care have both encouraged providers to empower patients to use as many resources as possible to care for themselves. While these programs and tools may cost practices, their value is tremendous as they keep patients engaged in their health.

Early Intervention

A study by UnitedHealth Group found primary care can save $32 billion in unnecessary emergency-room visits every year. Primary care can treat bronchitis, flu, low back pain, strep throat, and other conditions that regularly land patients in the higher cost ER setting. These visits can add up fast in terms of avoidable medical costs that are inherent in today’s system. Building strong patient-provider relationships will create a more educated consumer and help reduce waste.

And that staggering figure only accounted for acute events. Primary care is key when it comes to wellness management. Providers can use tools like patient portals to manage chronic conditions such as diabetes. Chronic conditions cost the healthcare system $1.1 trillion in 2016. As older patients are disproportionately affected by chronic conditions, it makes sense to look to Medicare Advantage for strategies to increase value, drive down costs, and improve patients’ quality of life.

Care Coordination

Care coordination is a core tenet of value-based care, but it is difficult to effectively implement. There are many impediments including insurance plan designs and customer choice. Simply put, how do we reconcile consumer choice while trying to manage cost, drive high quality, and coordinate the care of a patient that may have multiple touchpoints with today’s complex healthcare system?

That’s where electronic health records (EHRs) can help. Robust EHRs can target gaps in care that are easily and swiftly closed. Perhaps a Medicare beneficiary missed their annual wellness visit or a patient forgot to tell their provider that they got a flu shot. An EHR that assists the provider in understanding, identifying and closing these gaps saves them time and helps patients live happier, healthier lives.

Similarly, EHRs can house a built-in network of preferred providers who deliver cost-efficient, high-quality care. More advanced EHRs can even notify a primary care provider when one of their patients is discharged from the hospital or registered at an ER so that the provider can schedule a follow-up visit to ensure their patient understands any instructions and is better prepared to manage their condition.

Then there is the patient. How do we best support information sharing between the patient and the provider in this environment of customer choice? A well-designed patient portal that is customer-centric and meets the patient where they are is imperative. As different generations age into Medicare, we need to align to their expectations and choices. This environment is demanding a patient portal that allows for a patient to easily engage with their provider in a manner in which they desire (virtual or in-office), one that supports effective, two-way communication and one that supports interoperability.

To tie this all together, I think it’s useful to quote Allyson Schwartz again.

“Nearly 22 million beneficiaries appreciate the affordability, simplicity, quality care, and enhanced benefits available in Medicare Advantage.”

Now, tweak the numbers and replace “Medicare Advantage” with “value-based care.” That perfectly illustrates how Medicare Advantage, with its patient-centered primary care, early intervention, and care coordination, is an excellent model for value-based care.

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