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The Employer Push for High Value Health Care

Posted by Dan Mazanec, MD on Feb 9, 2016 4:18:54 PM

HCA, Verizon, and 18 other major companies form The Health Transformation Alliance 

The transition to a value-based payment system in health care is clearly accelerating. For years, we’ve been bombarded with the buzz words “value” and “outcomes” as the core drivers of a future “brave new world” in health care delivery which would someday supplant the traditional model based on fee-for-service. Exactly how and when this transition would occur has seemed uncertain and vague. With the announcement last week of the Health Transformation Alliance the road forward became a bit less murky. 20 prominent employers, including American Express, Caterpillar, Coca Cola, HCA, Macy’s, Shell Oil and Verizon, have decided to pool their data on the 4 million lives covered by their respective health plans. The aggregated data includes both cost and outcome of treatment. By linking outcome and cost (i.e. value) the Alliance hopes to identify providers and practices who deliver high value care for certain illnesses. By steering employees to these “best practices”, the companies hope to bend the health care cost curve and make employer funded health care sustainable. The undesirable alternative is increasing copays and deductibles or reducing employees eligible for healthcare by reducing work hours.

One of the key mechanisms that is driving this shift is the rise of employer-managed health plans.  Under these forms of insurance, the risks associated with waste and poor outcomes are carried exclusively by the employer.  While high degrees of waste and poor quality would certainly negatively impact an employer's bottom-line, being self-insured represents a tremendous upside opportunity as well.  Many employers, such as Boeing and Intel in the Pacific Northwest, have partnered with health systems such as Virginia Mason to create value-based reimbursement models.  Collaborations, such as the Healthcare Transformation Alliance, provide insight to the entire supply chain in a way that was previously a black box, controlled exclusively by large payers.

The onus will be on physicians and health care organizations to demonstrate superior clinical outcomes at competitive cost. This will require organizing clinical work along the best evidence-informed practice guidelines and routinely collecting meaningful clinical outcome data. Standardizing routine care with accepted guidelines should reduce costly and unnecessary variation in clinical practice. Publishing and simply distributing guidelines hasn’t been very effective in changing practice. Actual utilization of guidelines is facilitated by integration of clinical decision support (CDS) into the electronic medical record (EMR). Adoption by practitioners is facilitated when the EMR interface is user-friendly and the CDS is provided in real time. Careful design of the workflow with input by front line clinicians improves efficiency and productivity, while not compromising the patient-physician interaction. Integrating systematic regular collection of patient outcome data into the process is critical to an ongoing reassessment of the clinical algorithm.

Clinical transformation to the value based model is a challenge best met by providing the clinician with the tools to assist in delivering and documenting the best evidence based care in a patient-centered environment.   The EMR “done right” is at the center of the process.

As always, feedback, suggestions, and dialogue are welcome.

- - DM

About Dan Mazanec, MD

Prior to joining Dorsata in 2016, Dan Mazanec, MD was the Associate Director of the Center for Spine Health at the Cleveland Clinic. Board certified in internal medicine and rheumatology, he has been a leader in the development of the emerging specialty of Spine Medicine. A frequent lecturer at international and national meetings, he has authored more than 70 book chapters and papers. He is an active member of the North American Spine Society with a particular focus on the development of evidence-based clinical guidelines as a member of the Clinical Guidelines Committee and the role of non- surgical care as chairman of the Rehabilitation Interventional Medical Spine Committee. Dan led the development of the Cleveland Clinic Spine CarePath which merges evidence-informed clinical management of spine disorders with patient-entered clinical outcome data focusing on optimizing value. He was the clinical lead for technologic enablement of the CarePath in the EMR and the implementation of the Spine Carepath across the entire Cleveland Clinic Health System.

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