Value-based bundles of care are reducing costs

 

Value-based care models have made tremendous gains in adoption across America’s health care system over the last few years. These types of models, plus the many deals between providers and insurers to offer vertically integrated healthcare, could reduce outbound and domestic medical tourism.

Value-based care is health care that works ‘smarter and better’ to help people live healthier lives. This new model of health care promotes better health, better care and lower costs through innovative partnerships with care providers and consumers.

UnitedHealthcare says its spine and joint solution programme reduced hospital readmissions by 22% and complications by 17% compared to non-participating facilities for customers that had joint replacement surgeries.  Readmissions after spine surgeries were reduced by 10%, and patients experienced 3.4% fewer complications compared to non-participating facilities.

Participating employers saved an average of US$18,000 per procedure. Eligible employees saved US$3,000 in out-of-pocket costs per procedure when accessing a participating facility rather than another in-network medical facility, with incentives such as cash, gift cards, additional vacation days for recovery, and health savings account contributions.

The bundled payment programmes contract with facilities and providers who are considered high value and pay based on episodes of care, such as knee or hip replacement, under a single fee or payment. The bundled payment method reimburses health care providers and facilities for a defined episode of care, such as knee or hip replacement, under a single fee or payment. This is a shift away from the traditional fee-for-service structure in which a care provider is paid for each treatment, appointment or test, generating multiple claims within a single, broader episode of care.

That is the system UnitedHealthcare uses for its value-based model. The programme is offered to employers with self-funded health plans and gives access to facilities that UnitedHealthcare determines are centres of excellence. These facilities accept bundled rates for knee and hip replacement, spinal fusion and spinal disc repair. All participating health care facilities have been independently evaluated for providing quality patient care and better outcomes.

UnitedHealthcare has now expanded the spine and joint solution nationwide to 46 facilities. That includes 115 employers and 3 million employees.

The group expects at least 150 million customers will be in value-based coordinated care programmes by 2025, compared to 15 million now. It is moving providers into value-based payments is one of the insurer’s fundamental goals to help modernise the healthcare system. Value-based contracts have reduced hospitalisations by 17% and cut overall costs by as much as 8%.

One in every three Americans enrolled in UnitedHealthcare benefit plans now access care from providers in value-based care relationships.

Value-based care puts the patient at the centre of the health care experience. Physicians encourage patients to be active in their health care and to engage in dialogue about their diagnosis and treatment options. Actionable data shared with physicians makes it easier for them to close gaps in care with individual patients, such as a missed screening or follow-up appointment.

Care providers have a complete view of patients’ health by sharing information among every health professional involved in an individual’s treatment, from primary care physicians to specialists. 

Consumers build stronger connections with their physicians, find it easier to access care and have more information at their fingertips.

Care providers receive the time and compensation to provide more coordinated care, which ultimately can reduce costs by minimising unnecessary care such as re-hospitalisation and redone procedures. Mobile tools and more transparent information make it easier to research and compare quality, cost and provider-specific information. Financial incentives reward consumers for choosing high-performing doctors who are identified as having measurably stronger outcomes.

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