By Joshua Claman

For nearly a decade, the healthcare tide has been slowly turning from fee-for-service to value-based care (VBC). In the last few years, the nation experienced a surge in this evolution as 48 U.S. states and territories now have VBC programs. The trend is growing among providers and payors, too, which have grown their value-based payment arrangements from 30% in 2015 to more than 52% now, according to the Health Care Transformation Task Force (HCTTF).

It’s clear that VBC is here to stay. But we can’t fully achieve its promise without addressing the way care is delivered and, as part of that, finding a better way to manage chronic conditions, such as heart disease, stroke, diabetes and arthritis, which account for more than 75% of all healthcare costs. Specifically, providers, payors and patients need to move to a health care delivery approach that matches the challenge of managing chronic conditions - from reactive, episodic, in-clinic care to a proactive, continuous, virtual model of care.

As we enter 2020, we expect to reach a tipping point in care delivery as tension between managing a mix of fee-for-service and VBC continues to increase. The shift towards VBC will be driven by aggressive investments to support more efficient VBC models of care and, ultimately, a new standard of care delivery. Three key areas of focus will be on:

#1 – Remote patient monitoring
With expanded reimbursements from the Center for Medicare and Medicaid Services (CMS), remote patient monitoring (RPM) adoption is expected to soar. Learning how to fully take advantage of RPM reimbursement codes and developing effective strategies for improving population health is a particular focus for healthcare systems that seek to move toward continuous, virtualized care for high-risk populations with multiple chronic conditions.

At the same time, consumer acceptance of wearable technology – like smartwatches and fitness trackers – is growing. More than 80% of people are willing to use wearable technology, which has opened the doors for healthcare providers to offer additional remote monitoring solutions. Wearable devices, such as ECG and blood pressure monitors, self-adhesive biosensor patches and other tools can give providers greater insights into patients’ conditions outside of office visits. This data may support different decisions about how to manage health and adjust prescriptions, diet or activity to yield better results.

But to successfully leverage RPM, there are two major technology hurdles to cross. First, data coming from remote monitoring and wearable devices must be able to integrate into existing workflows, such as electronic health records (EHR). And there must be a continuous feedback loop between provider and patient, to ensure the data can become actionable insights.

Second is connectivity. For healthcare providers with patients in rural and underserved communities, the move to 5G and accessibility to broadband for telemedicine applications could limit the ability to offer RPM. Some more remote areas face the greatest number of patients with chronic conditions. For example, the prevalence of diabetes is 41% higher than the national average in some of Georgia’s least-connected rural communities, and the likelihood of dying from diabetes is higher too.

One of the keys to connecting patients in hard-to-reach rural areas is use of “white spaces,” or unlicensed TV spectrum in the VHF and UHF bands. The Federal Communications Commission is examining how this technology to connect areas where 5G cannot reach, such as in areas of difficult terrain or where wireline providers do not reach with broadband service.

#2 – Increasing payors’ role in VBC transition
Payors are now seeking a more active role in supporting providers as they transition to VBC. Payors and employers have been faster to adopt consumer-facing digital health tools to encourage patients to proactively manage their health, and they are taking a more active role in supporting patients medication adherence and attention to regular check-ups and screenings. However, multiple patient touch points from payors, providers and employers, can cause confusion for patients and fragment healthcare.

Payors will continue to explore ways that technology can help them align with providers to improve population health outcomes. This will include social determinants of health (SDoH) elements, which require new and innovative ways of engaging and fully understanding patients.

Some payors have already indicated that they want to help providers transition to technology and access resources to manage the risks – either real or perceived – associated with the evolution to VBC. For example, Humana said recently that it “aims to support advanced payment models with technology to allow providers to access information traditionally in the electronic medical record and claims systems to help manage that risk at their level.” The insurer also indicated that it would offer staff and other resources to help providers understand the data required.

#3 – Putting focus back on the patient
Greater reliance on patient reported outcomes (PROs) and SDoH is putting some of the focus back on the patient.

PROs include survey tools that capture the patient's experience in their own words, including their perspective on physical function, pain, and mental and social wellbeing. Real-time utilization of PROs can help providers share decision making with patients, improve quality of care and better allocate resources. While the Medicare Merit-based Incentive Payment System (MIPS) reimbursement and bundled payment pilots is seeking to help providers justify and optimize compensation for routine collection of PROs, perceived technological barriers and cost has thus far thwarted wider adoption.

SDoH are economic and social conditions that could impact an individual’s health. This can be assessed by third-party demographic information – such as zip code, socioeconomic factors, environmental concerns or other data – that affect the health of broader populations. This is important knowledge for providers to have since medical care is estimated to account for only 10% to 20% of the modifiable contributors to a health outcomes for a population. But PROs also are important in evaluating SDoH, since payors and providers are unlikely to infer transportation issues, food insecurity or other social conditions based solely on census data; they prefer to hear it directly from the patient.

The desire to improve population health and the lives of those with chronic conditions - while containing medical costs and eliminating unnecessary treatments - is fueling the momentum behind VBC. And it will get stronger, as providers embrace remote monitoring and patient-focused data, and payors extend more support for new technologies and processes to help providers succeed in delivering VBC.


About the Author: Joshua Claman is the CEO of Rimidi, a cloud-based software platform that enables personalized management of chronic cardiometabolic conditions across populations. He has over 25 years leading technology businesses in Asia, Europe and the Americas. His industry experiences span his time in Dell in several senior executive positions, including the founding and development of Dell’s European Healthcare business, to his role as president of ReachLocal, one of the largest advertising technology companies in the U.S., and serving as the chief business officer of Stratasys, a leader in 3D printing in the medical field. Josh is a strong advocate for the promise of technology.