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Analytics driven by artificial intelligence could transform value-based care by addressing long-standing inefficiencies and enabling providers to deliver better outcomes at lower costs.
This is among the key findings from a HealthScape Advisors report, which also highlighted the persistent challenges facing value-based care.
Despite significant investments, value-based care (VBC) has struggled to achieve its original promise of improving care quality and reducing expenses.
The industry’s perspective is that paying some providers prospectively based on outcomes – rather than retrospectively based on each service provided – tends to better support patient health and reduce overall excess spend for insurers.
WHY THIS MATTERS
The report noted one of the biggest issues with VBC is its reliance on complex financial models instead of direct provider enablement.
Over time, plans have introduced intricate reimbursement structures with numerous attribution, utilization and quality measures, frameworks which require providers to navigate conflicting metrics and analyze vast amounts of claims data.
It’s a process that often overwhelms providers, making it difficult for them to focus on improving care delivery.
“Providers are stuck navigating endless data while being held accountable for outcomes they couldn’t influence,” the report stated.
Fragmentation within health plans adds another layer of complexity. VBC program management is often spread across quality, network, and product teams, leading to disjointed efforts and inefficiencies.
AI presents an opportunity to address these challenges and bring VBC closer to its intended goals.