By Patty Hayward

The U.S. healthcare system is slowly but steadily shifting from the fee-for-service model to value-based care (VBC) with the twin primary goals of improving care and controlling costs. While VBC shows promise, many provider organizations struggle to meet the quality and financial metrics stipulated in value-based contracts under which providers assume partial or full risk for failing to meet those standards.

Falling short of VBC performance requirements can be costly. Some provider organizations have had to make large payments back to insurers when they underperformed on at-risk contracts. The Centers for Medicare & Medicaid Services, which has been leading the transition to VBC, primarily through Medicare payment models, is beginning to penalize healthcare organizations that fall short of the goals.
Not surprisingly, the financial risks of a VBC contract can be a barrier to adoption. In a survey of providers, payers and integrated “payviders” by the Healthcare Financial Management Association (HFMA), 61% of respondents said a reluctance to assume downside risk was a “significant factor” in their organizations’ decisions to not adopt VBC.

Transforming contact centers
A lack of data is often a primary obstacle to providers fulfilling their VBC contracts. Seventy-five percent of respondents to the HFMA survey said gaps in data availability have hurt their organizations’ performance under VBC programs.

EHRs have the ability to inform doctors during an appointment whether a patient is overdue for a flu shot or other preventive measures. The key value driver is not just having the data but surfacing it at the right moment to engage the patient and inform care decisions.

Providers also apply this concept to population health. That same data revealing a gap in care during an appointment can also be used to target outreach to patients with reminders. While these programs are important, outbound phone, text, mail, and email campaigns are limited in reach and can be expensive. However, there is another way for provider organizations to reach patients without launching new campaigns. It’s through their contact centers.

Historically, healthcare organizations have regarded the contact center as a cost center, a platform for conveying information to patients and plan members, facilitating basic tasks such as making and canceling appointments, answering questions about coverage or billing, and more. Today, however, AI-enabled contact centers can be value drivers, especially in a VBC system.

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