3 value-based care considerations to prioritize in a health plan

COVID-19 has driven home the potential of value-based care to impact incentives, improve quality, ensure appropriate care, and lower costs in a health care ecosystem that is far from perfect. As employees leave jobs at record rates, employers and their benefits advisors should have a keen interest in working with payers who are undertaking value-based care in a serious way, and are investing in the technology that will make it possible.

In the value-based care delivery model, providers are paid based on patient health outcomes. Under agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. This differs from a fee-for-service approach, in which providers are paid based on the volume of health care services they deliver. The “value” in value-based health care is derived from measuring health outcomes against the cost of delivering the services.

Challenges & opportunities

For employers and benefits consultants, evaluating health plans on an annual basis prior to open enrollment should include some hard questions about whether these plans are keeping up with the digital transformation taking place in health care, which is truly essential for meeting employees’ evolving needs. Leading plans are innovating to address the cost per employee in employer-sponsored health insurance. In 2021, this jumped 6.3%, representing the highest annual increase since 2010, leaving employers, advisors and payers alike to grapple with an array of options and opportunities to drive health care costs down.