Why employers should care about community-care networks
Value-based care requires a holistic view of the patient, the data for which hinges on community care networks.
The growing popularity of value-based care (VBC) reimbursement models is driven by the desire to improve patient outcomes while lowering health care costs for providers and payers. Among the latter group are employers that either provide health insurance to employees through a health plan or self-funding.
Like insurance companies, self-funded employers have a vested interest in controlling health care costs and promoting wellness. The focus of VBC is proactively keeping people healthy, rather than treating them only after illness.
Related: Future-state thinking: Reimagining value-based employee benefits
As a holistic approach to health care, VBC requires a full view of the patient. This can be obtained through social determinants of health (SDoH) data that offer insights into conditions and circumstances impacting a person’s health, such as environmental and social factors. True VBC also addresses issues of diversity, equity, and inclusion (DEI) in the health care ecosystem.
By collecting and analyzing SDoH data, promoting health literacy and supporting DEI values, VBC can achieve greater health equity, better outcomes, and reduced health care costs. Those are huge wins for employers striving to keep employees healthy, achieve workplace goals, and better manage the costs of a health benefits program.
So where can that SDoH data be accessed? Primarily through community-based organizations (CBOs), such as social service agencies, charities, foundations, and faith-based groups. These community care networks (CCNs) possess SDoH data, which research shows has a disproportionate impact (roughly 80%) on a person’s health.
Without such data, VBC initiatives are doomed to underperform and could even fail. But by accessing community care networks, payers and providers can enable a holistic patient approach that includes SDoH and DEI in its design.
To be effective, however, CCNs need some key patient-facing and backend capabilities, including:
- Integrated data sets that combine traditional health care data with external SDoH data
- Digitization of unstructured data to enhance analytics for risk assessment, prediction and prevention, including patient-provided inputs
- Automated referrals, the scaling of efforts via applied machine-learning combined with distributed ledger technology (DLT) “smart contracts”
- Communication and consent management functionality to expand access and diversity of recruitment and participation in research, clinical trials, and treatment alternatives
- Automation of the service-invoice-payment continuum to support “convener” models where community-based providers are reimbursed and/or incentivized
Above and beyond these technical capabilities, several functionalities are essential when combining VBC with CCNs. These include the ability to:
1. Address SDoH in a focused manner. SDoH data can be leveraged by stratifying a patient population to gain a greater understanding of subgroups and their unique characteristics and challenges. It is imperative, though, that external data is incorporated to provide a holistic view via a longitudinal health record.
2. Triage down to areas of emphasis. Once a population has been stratified, health care stakeholders must identify and align programs to address various social determinant buckets. This necessitates an ability of CCNs for behavioral health literacy, health advocacy, and similar initiatives to ensure patients or health plan members know how they can obtain assistance or service.
3. Close the loop on referrals to eliminate care gaps. If a provider has referred a patient to a CBO or social service agency, that provider must be able to confirm that service, in fact, has been rendered to the patient and that protocols are followed.
4. Capture data from the edge. Whether it’s structured or unstructured, data captured from the “edge” – that is, in the home and community, physically and through digital technology – allows stakeholders to see changes in the patient’s health status far sooner than if they rely on a scheduled appointment, claim submission, or wait until the patient suffers a major health episode.
VBC isn’t attainable without inclusive value-based benefits design and implementation of value-based benefits administration that incorporates health at the edge. That means reaching patients to address the needs of vulnerable populations and empower patients through individualized, or precision, care.
Integrating traditional medical networks with CCNs in a way that aligns stakeholders in programs fully inclusive and equitable is a formidable but worthwhile challenge. And it’s the best strategy for keeping people healthy and helping them realize their full potential.
Lynn Carroll is the chief operations officer for HSBlox, whose solutions assist health care stakeholders at the intersection of value-based care and precision health.
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