Price transparency and true interoperability — A vision for the future of value-based care

The healthcare industry often seems to get trapped in the cycle of repeatedly doing the same things while expecting dramatically different results. Value-based care initiatives are no different. Many providers have made large investments in technology related to value-based care, but many of these investments have failed to achieve intended results.

Becker's Hospital Review recently spoke with Bill Nordmark, President and CEO of Enlace Health, about the challenges associated with value-based care. Mr. Nordmark outlined the steps necessary to drive healthcare from fee-for-serve to value-based care.

Value-based care has failed to deliver because it's too broadly defined

According to Mr. Nordmark, one of the major problems plaguing the transformation to value-based care is that value-based care has become a "catch-all" term. The healthcare industry seemingly classifies everything as value-based care. "Telehealth, for example, has created some additional access for patients — which in many situations provides great advantages and value — but calling it 'value-based care' is a misnomer," he said. "Telehealth is simply a service that sits on the periphery of the healthcare system and is a replacement for office visits. Under the CARES Act, telehealth is reimbursed at the same price as an office visit, so it's not truly driving value."

Focusing on peripheral solutions like telehealth or patient health tracking apps does nothing to fundamentally change the processes and incentives associated with the legacy fee-for-service care model. Payments still happen in arrears, often long after care has been delivered, and patients have no visibility or transparency into their costs in advance.

Important to the solution is the need to narrow the definition of value-based care down to its core idea –  paying a clear set price up front for a specific healthcare service. "We need to fix the core systems that enables this vision," Mr. Nordmark said. "This means creating a world where patients pay and consume care based on value, not based on volume. This would open up many opportunities downstream for initiatives related to health equity and social determinants of health."

Fixing core healthcare systems to enable value-based care requires a fresh look at interoperability and technology

Work is needed to break down the silos  that hinder interoperability at the point of care. This will require the private sector to come together and form payer-provider-technology partnerships which address interoperability challenges.

The other issue is migrating IT systems away from today's predominate fee-for-service infrastructure and towards an infrastructure that truly supports value-based care. "By default, all of the systems out there today work based on volume, fee schedules and claims," Mr. Nordmark said. "Unfortunately, the big core systems have inertia built into them which impedes progress. We can't change that infrastructure overnight by ripping it out and replacing it. Instead, we must use technology to transition from the current infrastructure to where we want to go in the future. That's where Enlace Health delivers value."

Enlace Health's vision of value-based care puts patients at the center of every healthcare event

Patient-centered care won't happen until people understand the price and quality of service in advance of receiving care. With this information, patients are able to make informed decisions about their health. "If employers want employees to move to high deductible health plans and put money in HSAs, the industry must drive towards value by publishing price and quality metrics before care is delivered," Mr. Nordmark said. "It’s the only way that patients can plan and use their HSAs effectively."

Enlace Health's strategy is to fix the healthcare system at its core by changing the way that care is consumed and paid for. By creating a bridge between technologies, Enlace Health's ecosystem enables healthcare providers to abandon today's highly manual processes and to fully embrace prospective payment episodes and risk arrangements.

"I come from a long line of healthcare professionals, and my family and I are users of the healthcare industry," Mr. Nordmark said. "Getting care today doesn't work the way it should. I'm passionate about transforming and driving true sustainability in healthcare. We're doing it today at Enlace Health. We know it's possible to render services in a way that drives down costs, increases quality, and drives value."

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