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Employers were forced, during the pandemic, to rapidly transform benefits packages. HR departments realized public sentiment had shifted towards meeting worker needs for improved, next-generation benefits; these included options to work remotely, a better work-life balance, or finding a position with better offerings of flexible hours as pay or benefits.
An estimated 157 million workers rely on employer-sponsored health benefits — far in excess of any other form of coverage. Recent reports show that employee-sponsored health premiums rose 22% across the past five years and 55% over the previous 10. Health spending in total is estimated to reach as high as $15,500 per employee and $22,000 per family.
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With workforce shortages, employers continue to struggle to fill open positions, retain current and qualified staff, and maintain employment at functioning capacity levels. Meanwhile, they are also facing skyrocketing health care costs at every corner. The heart of the matter is that businesses are searching for differentiated benefits while controlling spiraling costs. Increasingly, value-based care is positioned as the best solution for bridging these priorities.
Value-based horizons
As our health care systems evolve, employers continue to actively search for ways to reduce spending and ensure staff receive proper care and treatment. Value-based care (VBC) has been the center of much discussion and attention, with promise and potential for desired and needed results.
VBC is a type of health care model that rewards based on the quality of care rather than the number of services offered. Metrics and analytics are used to help reduce hospital admissions, identify at-risk demographics, and implement payment models to control expenditures. As a result, VBC is often referred to as a "patient-centric" form of insurance emphasizing prevention and detecting potential health threats at early stages.
Other aspects of VBC include the importance of care outcomes, assisting patients in navigating complex health care systems, and integrating care coordination to optimize outcomes. This kind of approach is designed to drive successful outcomes while controlling costs and keeping staff healthier and happier.
Payment delivery transformation
An emergence of internal and external factors has driven the health care industry's interest and investment in value-based care business models, with repercussions extending across finance, technology, and provider organizations.
The underlying driver of value-based health care is to align reimbursement with positive health outcomes. As a result, providers are compensated for demonstrated quality and results instead of services delivered. It's a model designed to align the vision of health care with the patient while dramatically reducing costs by minimizing extreme interventions. It achieves this by investing more resources in preventive care and chronic care management. Providers are then incentivized to offer optimal preventive care. But carrying through on the vision requires advanced technology to identify those at risk and measure outcomes within a new financial model.
VBC utilizes a team-based approach to contract with a carrier's high-performance network or within set models such as patient-centered medical homes and bundled payments. Employers are finding solutions through technology that offers a bundled adjudication application, integrating financial claims data and turn-key capabilities for billing, collection, payment and distribution. Enhanced platforms access and leverage industry standard claims, processing methods and protocols to ensure minimal impact on existing revenue cycle management and payer core administration systems.
Employers also have the option to partner with advisors and health plans with technology that can identify key demographics and risk factors for a group of employees that might benefit from more intensive prevention and wellness programs. Once identified, using in-depth analytics tools, care teams can proactively manage clinical and financial risk within the population.
In this kind of platform, accessing integrated analytics, administrators can conduct funds flow analysis and reconciliation for beneficiaries that remain in flux. This assists in forecasting profitability and prevents under and overpayments that could significantly affect revenue and care delivery. Ultimately, this kind of technology, centered on a VBC delivery model, will help employers reduce expenditures and improve overall financial stability.
As HR departments and employers continue adapting to the post-pandemic health care landscape, more are finding a pathway to realizing success through adopting and implementing value-based care delivered via innovative data management platforms. Able to bridge organizations' priorities, VBC allows leaders to stop searching for differentiated benefits and control spiral costs. Now, value-based care is positioned to perform a crucial and growing role for employers looking to offer next-generation benefits, retain a healthy workforce, and attract new talent.
David L. Morris is the EVP and Chief Commercial Officer of Cedar Gate Technologies.
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