- Payer-provider collaboration, holistic healthcare approaches that address the social determinants of health (SDOH), and the use of health IT tools will be among the most important drivers of value-based care, Aetna says in a new report.
Aetna’s 2018 Health Care Trends suggests that the adoption of value-based care has increased as the US faces rising healthcare costs and more costly chronic conditions, increasing the need to leverage innovative technologies.
“World Health Organization (WHO) figures show that our average life expectancy is lower than 30 other countries, including Switzerland, Australia and Canada,” Aetna said
“But the tide may finally be turning, with a monumental shift in how we approach health care, towards a personalized approach that focuses on each individual and all aspects of their well-being.”
Five percent of the US population accounts for 50 percent of national healthcare spending, according to HHS data cited by Aetna. The adoption of value-based care models is expected to account for 59 percent of healthcare payments by 2020, as the healthcare industry uses value-based care to address these high-cost utilizers.
Payer-provider collaboration is going to be a major driver of value-based care, Aetna suggests, because of its success in launching value-based collaborations with provider systems across the US.
Aetna has formed value-based partnerships with five provider systems including Banner Health in Phoenix, Texas Health Resources in the Dallas-Fort Worth area, Nova Health in northern Virginia, Allina Health in Minneapolis, and St Paul Sutter Health in northern California.
Aetna believes payers can successfully drive value-based care if they align goals with providers and allocate resources and funds to host collaborative efforts.
“We partner with them, using their clinically integrated networks and affiliated physicians as the platform on which to build a value-based offering for health care consumers,” said Brigitte Nettesheim, President of Transformative Markets for Aetna.
“That couldn’t happen without economic alignment between the entity paying for the majority of services and the organizations providing those services — being able to say: ‘We’ll pay for a variety of services, provided we have joint accountability to monitor and assess outcomes.’”
Value-based care will need to focus on all the factors that influence individual health, including social determinants, Aetna believes.
Aetna referenced a study from the Kaiser Family Foundation that found medical healthcare only accounts for 10 percent of preventable mortality. Diet and exercise accounts for 40 percent, genetics account for 30 percent, and social conditions account for 20 percent.
Aetna uses grants from their philanthropic arm, the Aetna foundation, to address holistic healthcare. One example is Aetna’s partnership with The Healthiest Cities & Counties Challenge, which offers $1.5 million for communities that strategically develop programs to address SDOH or other significant improvements to community well-being.
Aetna’s recommendations for payers to advanced holistic healthcare include assessing community needs, informing SDOH research, allocating community resources, and determining the impact of holistic healthcare policies.
Aetna sees wearables, telehealth, and remote monitoring technologies as other major drivers of value-based care.
The payer cited a Forbes analysis that found 65 percent of interactions with healthcare organizations will occur through wearables and healthcare devices by the end of 2018.
Technology would potentially allow providers to maintain the health of their patients from without the need for hospitals stays.
“The next step in wearables will be to make them relevant to people who wouldn’t normally use them,” said David Edelman, Chief Marketing Officer of Aetna.
“Most people who use a wearable today are already active, healthy and concerned about their health. We need technologies that are tied to medicines and tied to specific therapies and conditions that provide people with real solutions to their health issues rather than just functional products.”
Aetna summarized their expectations for value-based care by suggesting that the healthcare industry will leverage data from various different sources to empower decision making. Data-driven decisions could help payers and providers address national health crises and local-level health issues.
“It’s clear that our healthcare system faces many challenges,” Aetna concluded.
“But by using data to identify successes and difficulties and shaping future policy with that information, we will be better equipped to overcome these issues and create a more personalized and holistic approach for patients, yielding better results at lower costs.”