As healthcare costs continue to climb and domestic health outcomes fall below other high-income countries, value-based care creates a sustainable advantage by paying providers based on patient health outcomes. Value-based care models (ours is advanced primary care, or APC) realign the incentives between payers, providers, and patients, allowing everyone to prioritize health outcomes over reimbursement.
It’s an effective approach that gives payers the ability to improve and sustain quality of care and member satisfaction.
Achieving value through consistency
APC helps payers achieve strong HEDIS quality scores and notably higher Star Ratings from Medicare Advantage populations. It’s accomplished four specific ways:
APC addresses the needs of each population, supporting continuous innovation: APC creates a single provider network that can quickly adopt new technologies or pilot new care delivery approaches without waiting for the rest of the healthcare system to catch up.
A single partner with aligned incentives creates broader alignment: Alignment on goals and financial incentives between those providing the care and the payer means everyone agrees on the best way to serve member panels.
Adaptability allows quick responses to emergent needs in a crisis: In situations like the COVID-19 pandemic, the model can quickly pivot to support virtual solutions (like video and phone appointments) because the revenue model isn’t dependent on members coming into the care center.
The member experience exceeds expectations because of the strength of the provider-member relationship: When providers focus on members’ social, mental, and physical well-being, patients consistently report that they have never felt so heard or motivated to play a larger role in their own health goals. It’s a direct result of a care delivery approach built around empathetic listening and longer appointments with providers.
While there are other effective APC plans available to payers, Vera’s APC model stands alone by giving payers the ability to construct a member experience that’s ideal for the specific needs of their populations — ensuring improved health outcomes, reduced total cost of care, and significantly higher scores across the board.
Leveraging informatics to meet the needs of your population
When 5% of a population accounts for 45% of all healthcare costs, it’s clear that healthcare needs population data to be useful. Data sets from claims, electronic medical record (EMR) data, and user-generated surveys inform how the APC model should be tailored for a specific population.
Here's how Vera uses informatics to drive improved health outcomes:
Serving high-impact segments first: An informatics platform segments the population by risk so that providers can provide care to the highest risk segments of the population first.
Conducting customized outreach: Care teams contact members using relevant messaging that speaks to their specific health situations and encourages them to visit care centers.
Closing care gaps: When data indicates that specific member segments are missing out on vital care, the model can be adjusted to fill that gap.
Data serves as the foundation of a population health management strategy and, when managed effectively and proactively, improves the quality of care and overall member satisfaction.
Improving the member experience for specific patient panels
Different approaches are necessary to improve the health outcomes of diverse populations. APC provides payers control over the experience within care centers to ensure that each population’s specific needs are met. Here are a few specific ways this happens in the APC model:
Customized care for customized needs: Whether it be implementing an occupational health program, offering travel vaccinations, or emphasizing a specific preventive screening, APC allows you to customize care to each population’s specific needs.
Increasing member access without increasing cost: Payers can solve the primary care shortage in their regions by embedding dedicated primary care access into existing health plans. With little to no cost to members, payers remove barriers (physical, financial, and even cultural) that previously kept members away from primary care centers.
Many solutions under one roof: Members benefit from the breadth of APC’s primary care services administered by physicians, nurse practitioners, physical therapists, behavioral health clinicians, and multilingual care teams.
Longer appointments address underlying issues: Because APC is built around improving health outcomes rather than volume or claims, members benefit from longer appointments with their providers— giving them the time to get at the root of their health issues.
Virtual care meets members where they are: Virtual care improves continuity of care and blends seamlessly with in-person services when needed — adapting to meet members wherever their busy lives take them.
It’s simple: When members’ needs are met, their experience improves.
APC improves population health
Population health management is complex. Payers face big challenges as they seek to increase the quality of care, improve satisfaction, and enhance the member experience.
APC supports each of these goals. Its ability to serve any population using insights from advanced informatics creates a system that can drive true outcomes. All-population care combined with aligned incentives ensures that care can be delivered exactly as your population needs. It’s not long before member satisfaction increases to meet the APC’s newfound value.