The U.S. healthcare system has been out of control, with public dialogue on its transformation trying to steer care delivery back on track for better outcomes and greater value. Inherently, the collective focus on chasing value means we all confront the faulty incentives of our volume-based past.
But can we maximize value without volume? Or are we just shifting the optics around our volume-dependent care delivery system as we refocus on population-level care coordination through stakeholder accountability?
Healthcare payment reform is continuing to drive providers away from fee-for-service incentives toward pay-for-performance goals and more meaningful health outcomes. Each patient’s improved outcome helps contribute to the overarching outcomes goal of provider groups and larger health systems, which are increasingly measured and reimbursed by health plans.
It seems we’re headed from volume to value, at least from what we’ve seen through the lens of the payer or health plan. But from the optics of the health system, the ongoing consolidation and acquisition of independent providers, medical groups, and hospitals is leading to a larger volume of services and outlets that can enable better outcomes across multiple patient types covered by private and public benefit plans.
Aside from growing ambitions, a critical component of today’s business model is data collection and analysis that shows improvements in outcomes and efficiency, leading to cost reductions. This is where pharma and biotech can bolster their value through the analytics efforts of their health economics and outcomes teams. Today’s value proposition has to be grounded in the outcomes and value that all market access stakeholders can see and relate to.
It’s critical to embrace and address the complex market dynamics impacted by payment reform, population growth, higher cost pressures, and the systemic need to substantiate value and quality outcomes.
We must also consider how care coordination and optimization impacts not only health consumers, but also pharma companies as they develop stronger relationships and more flexible approaches to engaging physicians and provider organizations. In doing so, we can all address healthcare stakeholder and organization needs as they continue to embrace value and outcomes goals within the complex healthcare system’s transformation.
Khawar Khokhar is EVP of market access for Klick Health.