Junto Health Fellow Parth Desai has been working on some program development here at Junto. Recently, he has been working on looking at the investment side of digital health and how things are shaking out for investors. This week he investigated value-based care and potential trends he sees in the market.
While much talk in the health policy world today has centered on the AHCA and how it might fundamentally transform the healthcare system, we can’t forget that another significant change has been transforming the healthcare system for a number of years. The volume to value shift that has reversed incentives for care provision – payment per care episode to outcome-driven payment – is driving change in the healthcare landscape and is poised to continue doing so despite an uncertain regulatory landscape.
A byproduct of the ACA, value-based care reimbursement models reward care providers who deliver higher quality care at lower costs. Post-ACA, the popularity of these models has grown amongst public as well as private payers. In fact by 2018, major commercial and government insurers have pledged to tie more than 75% of their payments to value metrics (up from 0% just 6 years ago). The passage of MACRA last year, with significant bipartisan support, reinforces the fact the value-based care is here to stay.
While regulatory bodies continue to support this change and industry consolidation suggests that plans and providers are re-positioning assets to better prepare for this future, change is moving much faster than the industry is or can. In fact only 3% of providers surveyed in the 2016 HIMSS Cost Accounting survey feel as if they have the technology and business models they need to be successful in a value-based care world. This has created significant opportunity for new entrants into the space and startup technology has rapidly evolved to plug the gaps. In the future value-based world, technology that can help health systems, plans, employers and consumers better coordinate and manage care as well as aggregate and analyze siloed clinical and financial data will define the future. Entrepreneurs would be wise to keep an eye on the below factors as major players in the ecosystem will likely aim to anchor their preparation efforts on them:
Data Aggregation and Analytics:
For many care providers, a fundamental challenge faced on the path to developing value-based care capabilities is a deep understanding of their own clinical and cost data. To achieve financial and clinical success in a value-based contract, providers need to price the clinical and non-clinical components of a care episode and this means access to data from multiple stakeholders and across the care continuum. Many providers are limited by this first step, unable to even access all they data they need. With data siloed across partners (e.g., claims data from payers) and oftentimes not interoperable many providers struggle to accurately aggregate/analyze it even when they do have access to it. Data that can be aggregated, standardized and accurately analyzed to inform decision-making is lacking in many healthcare organizations today. Therefore, technologies that can better enable this and leverage analytics to guide more accurate and cost-effective clinical decision-making will be received favorably. A handful of startup technologies have shown potential in addressing this growing trend:
- Remedy Partners- Remedy Partners is one of a few companies working with the CMS to help providers with the bundled payment demonstration. The Darien, Conn.-based firm is working with more than 1,200 hospitals, physician groups, skilled-nursing homes and home health agencies. Remedy provides the software, analytics, training, networking and other administrative roles associated with bundled payments.
- Jiseki Health- Jiseki Health is a company that has recently received publicity as part of GE Ventures and Startup Health’s call for value-based care innovation. It’s mission is to bridge the gap between hospital-provided clinical care and supportive community health resources with technology to enable better and more accountable service delivery, and ultimately get patients the right services at the right place at the right time and for the right cost.
- HealthQX- Recently purchased by McKesson, HealthQX’s technology enhances McKesson’s ability to help customers transition to value-based care by automating and scaling complex payment models, such as retrospective and prospective bundled payment.
Care Coordination and Management:
Without streamlined clinical operations and coordination amongst clinical care providers, delivering care aligned to a value-based reimbursement model will be a challenge. With so many stakeholders involved in the delivery of a single care episode across multiple care settings, coordinating the care delivery process is often a roadblock to value-based care preparation efforts. Technology that can standardize clinical workflows/tools, be easily replicated and seamlessly integrated has a higher likelihood to be adopted by clinical care providers (physician engagement and adoption can be a major hurdle to new technology). A handful of startup technologies have shown potential in addressing this growing trend:
- Cureatr- Founded in 2012 by physicians in New York City, Cureatr helps accountable care organizations, hospitals and health systems, specialty care providers, payers and physician group practices track patients in real-time throughout the care continuum and improve care coordination. Cureatr builds networks of Care Transition Notifications (CTNs) paired with a mobile care coordination platform. Cureatr’s CTNs alert clinicians in real-time on mobile or desktop applications when an attributed patient is receiving care anywhere within a region and delivers necessary information that is essential to reducing preventable hospitalizations and avoiding readmissions.
- Grand Round Table- Grand Round Table (GRT) provides innovative clinical decision support software integrated into the electronic health record. The technology allows health care providers to tap into the collective intelligence of experts to arrive at the correct treatment plan faster on sick, diagnostically challenging patients. The technology is designed to help hospitals and clinics save time and money by directing care teams to appropriate solutions faster, reducing the number of unnecessary tests, ineffective treatments, and consultations that patients currently receive.