Health Plan-Provider Collaboration is Essential for Value-Based Care

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In the healthcare industry, there’s been a shift towards value-based care (VBC), a model that emphasizes the importance of delivering high-quality patient care while reducing overall healthcare costs. For value-based care to be successful, it’s not only important but essential that health plans and providers collaborate closely.

Why Value-Based Care?

Under a VBC model, healthcare providers are incentivized to achieve positive patient outcomes through care delivery. Rather than focusing on the traditional fee-for-service model, where providers are paid for services rendered often opting for volume over quality, the focus in a VBC model shifts to patients’ health. When patients have better outcomes, they’re less likely to have a costly visit to the emergency room.

Even though many organizations are shifting towards value-based care, it’s proven to be a slow process. In fact, according to a 2022 report from the Medical Group Management Association, value-based contracts only accounted for 7% of medical revenue among primary care specialties, 6% among surgical specialties and 15% among nonsurgical specialties. 

The Importance of Health Plan-Provider Collaboration

Part of this slow shift may be due to the fact that the healthcare industry needs more organizations to adopt and partner together to successfully shift to a value-based care model. One such partnership is health plan and provider collaboration. Health plans, such as insurance companies and government programs, provide the funding for healthcare services while providers, such as hospitals and physicians, deliver the care. It’s necessary that providers who want to focus on VBC partner with health plans who are willing to implement the model. If both parties opt for VBC, they can better collaborate through goal setting, payment structures and reimbursement rates. By working together, health plans and providers can ensure that patients receive the best possible care while also controlling costs.

Improved Coordination of Care

One of the key advantages of health plan-provider collaboration is improved coordination of care. By collaborating, health plans and providers can ensure that patients receive the appropriate treatment at the right time. This approach can help reduce the risk of medical errors, prevent unnecessary and costly hospital readmissions and improve patient outcomes. According to study on JAMA, Medicaid patients that experienced a coordinated care approach had lower emergency department use and follow-up visits, resulting in a savings of $4,295 per beneficiary care event.

In practice, this can present itself in a multitude of ways. For example, if a patient has a chronic condition such as kidney disease, health plan-provider collaboration can ensure that the patient receives regular check-ups with their primary care physician and isn’t missing any dialysis treatments. By managing the patient’s condition effectively, healthcare providers can prevent complications that could lead to costly hospitalizations.

Shared Accountability

Another advantage of health plan-provider collaboration is shared accountability. Under the VBC model, both health plans and providers share the responsibility for delivering high-quality care while controlling costs. By working together, health plans and providers can identify areas for improvement and develop strategies to address them.

For example, if a hospital has a high readmission rate for a particular condition, health plans and providers can work together to identify the root cause of the problem and develop strategies to reduce readmissions. This approach can lead to better outcomes for patients and lower costs for health plans.

Data Sharing

Data sharing is another key aspect of health plan-provider collaboration. By sharing data, health plans and providers can gain a better understanding of patient needs and identify areas for improvement. This approach can help reduce the risk of duplicative tests and procedures and improve the overall quality of care.

For example, if a patient receives care from multiple providers, data sharing can help ensure that each provider has access to the patient’s complete medical history. This approach can help prevent medical errors and ensure that the patient receives the most appropriate care.

Real-Time Insights & Alerts

To improve value-based outcomes, health plans and providers not only need to share patient data, but also need accurate, timely and distilled insights to make the best care decisions for their members and patients. At Bamboo Health, our care coordination and value-based care solutions help health plans and providers distill patient data into actionable insights. Our Care Gaps solution delivers immediate notifications and detailed insights to help providers and health plans find and close open gaps in care, deliver better outcomes and improve quality measures, which helps healthcare organizations move towards value-based care.

In an industry that continues to shift from volume to value, health plan-provider collaboration is essential for the success of value-based care. By working together, health plans and providers can improve coordination of care, share accountability and facilitate data sharing. Through better collaboration, and ultimately better care coordination, patients will see improved outcomes and the system will see lower costs of care overall.

Is your organization looking to leverage real-time insights to improve value-based care outcomes? Contact Bamboo Health today to learn more.