Navigating Value-Based Care Through Technology and Automation
In a recent webinar titled “Navigating Value-Based Care Through Technology and Automation,” Dr. Sandhya Gardner, MD, Chief Medical Officer at HealthEdge Clinical Solutions, and Mr. Jeff Rivkin, Research Director of Payer IT Strategies at IDC Health Insights, shared valuable insights on the current state of value-based care and the role of technology in its implementation.
The webinar kicked off with Jeff highlighting the advancements payers have made in recent years in value-based care. Payers are transitioning from being merely transactional entities to becoming active partners in care. With the advent of exchanges and marketplaces, payers have focused on improving the shopping experience for enrollment as well as the overall patient satisfaction and engagement. The rise of convenience as a leading factor in healthcare decision-making has led to the emergence of models such as retail health, telehealth, hospital at home, and care anywhere, all aimed at providing accessible and patient-centric care. Additionally, payers have been actively engaging in interoperability, striving to establish an open and seamless system where data can flow between payers, providers, and patients. Artificial intelligence and data analysis have played a crucial role in leveraging payer data to identify care gaps and predict patient needs.
The Role of Technology in Value-Based Care
According to Dr. Gardner, technology plays a pivotal role in facilitating the transition to value-based care by automating manual workflows and leveraging data. Technology can support the efficient delivery of care and improve patient outcomes, while also improving the reach of care management teams by identifying and stratifying at-risk populations. Modern care management solutions offer configurable algorithms to rank member risk based on multiple data sources, including clinical diagnoses, pharmacy claims, and health risk assessments. Digitalizing the intake process and automating care plans can further streamline care management workflows, making them more efficient and increasing member engagement and satisfaction.
Harnessing the Power of Data
Health plans have access to vast amounts of data, ranging from patient experience surveys to medical and pharmacy claims. The challenge lies in sifting through this data to identify relevant and actionable insights. In the webinar, Dr. Gardner emphasized the importance of leveraging data to drive quality improvement rather than merely focusing on compliance. She highlighted the need to surface the right data to the right stakeholders at the right time, enabling health plans to improve performance and outcomes across populations. For instance, data capture can aid in identifying gaps in care and leveraging technology to close those gaps. HealthEdge’s solutions provide configurable assessments and gap closure functionalities, empowering health plans to enhance quality and performance scores while improving patient outcomes.
Adapting to Regulatory Changes
The speakers discussed how technology can assist health plans in adapting to value-based regulatory changes. Examples included incorporating health equity stratification data into assessments to address disparities in care quality across different racial and ethnic groups. Furthermore, modern technology can help health plans meet the requirements of Medicare Advantage and ACA 2023 regulations, particularly in collecting social determinants of health data through health risk assessments (HRAs). Another critical aspect is provider data management and directory requirements, under the No Surprises Act, where HealthEdge’s upcoming provider data management solution can help health plans ensure accurate and up-to-date provider network information.
Accelerating the Journey Toward Value-Based Care Success
This webinar shed light on the progress health plans have made and the opportunities they have in front of them as they pursue their value-based care strategies moving forward. As payers continue to evolve toward become active care partners, embracing convenience and interoperability to enhance patient satisfaction and engagement is critical. Technology solutions have enabled the automation of manual workflows, streamlined care management, and facilitated data-driven decision-making. By harnessing the power of data and leveraging advanced technology, health plans can improve quality, outcomes, and member experiences in the value-based care landscape.
To access the full webinar on-demand, watch the recording here. If you’d like to learn more about how HealthEdge can support payers with value-based care, visit www.healthedge.com.
