For years, health plans and provider organizations have been attempting to make value-based care work for them and their members. Yet for many, success has been elusive.
Now, a new generation of technologies is helping advance value-based care by leveraging AI to equip payers and providers with the right data and predictive analytics to foster alignment, improve outcomes, and manage costs.
This was the focus of a panel discussion at Becker’s 3rd Annual Spring Payer Issues Roundtable. Panelists included:
- Lila Benayoun, chief operating officer, MetroPlusHealth (New York)
- Dave Dehommel, vice president, payer strategies, Reveleer
- Robert Groves, MD, chief medical officer, RiskAverse
Three key takeaways were:
- Health plans are leveraging AI and data technologies to predict a person’s health outcomes and intervene early. Health plans are working to improve a person’s engagement with the preventive health programs and services they already offer.
According to the panel, the number of people who typically participate in preventative programs is marginal. This low participation can doom even the most thoughtfully designed programs. “If you can’t get folks to pay attention to your message, you can’t get them onboard,” Dr. Groves said. “If you can’t get them onboard, you can’t get your ROI.”
RiskAverse leverages an AI solution that determines when people are most amenable to engaging with messages about their health and available healthcare services. “For programs with [previously] single-digit participation, it increases the number of individuals who sign up by 2X to 7X,” Dr. Groves said.
Health plans are also investing in techologies offered by companies like Reveleer which improve medical data acquisition and convert data into clinical insights. When shared with providers, those insights can support better point-of-care interactions and early intervention. “We’re capturing an individual’s full burden of illness , which provides insights to the clinicians so they can provide appropriate care,” Mr. Dehommel said. - A proactive, aligned approach better supports value-based-care objectives. Achieving value-based-care goals requires aligning financial incentives between providers and payers so both parties are inclined to intervene early, when care is less expensive. Reveleer’s data acquisition technology serves that goal.
MetroPlusHealth approached aligning incentives with its provider network by looking at the quality measures of providers who serve a high number of its plan members. “We would tell them, ‘You’re leaving half a million dollars on the table because of [unrealized savings due to] gaps in care.’ We collaborated to move the needle on asthma indicators, which also helps the providers feel supported because the health plans bring the data to them,” Ms. Benayoun said.
Reveleer’s clinical intelligence tools enable health plans to glean insights from patients’ EHR records and draw inferences about what their future costs of care may be. This is information insurers would typically only have after they processed the individuals’ reimbursement claims — up to 90 or even 120 days after service has been provided. “If you are in a shared savings or shared risk agreement, you can share those clinical intelligence insights much sooner and be successful in that value-based care arrangement,” Mr. Dehommel said. - The best AI investments will solve patient and clinician problems from the bottom up. The tech investments poised to yield the greatest future benefits are those that solve deeply rooted human problems.
For example, MetroPlusHealth is piloting a technology that mitigates isolation and loneliness among its homebound, elderly population. The device works similar to Amazon’s Alexa and can be moved around the home.
“We’re going to be measuring the success of that pilot by using feedback from our members because it’s a dual exchange technology where the more you engage with it, the smarter it gets,” Ms. Benayoun said.
Dr. Groves also provide insights, stating healthcare organizations need to move away from addressing challenges by using top-down metrics. Instead, best practices and methodologies should emerge from the front lines, and from clinicians caring for people on a daily basis. “This is where AI might be able to give us the magic so that we can design processes that work for the doctors that are delivering care and stop the top-down metrics, which lead to tons of unintended consequences,” he said.
The Bottom Line
Technology is not a silver bullet, but it is a powerful enabler. When data, AI, and clinical insights are paired with collaboration and a deep understanding of patient needs, value-based care becomes more than a goal, it becomes achievable.
