As noted in the first article in this series, traditional value-based (VBC) care models largely focus on economic incentives for healthcare providers and facilities. Many VBC organizations lack the infrastructure or scale to integrate factors that impact how patients interact with the healthcare system, collaborate with providers, or follow treatment recommendations. Failure to address and address these needs may result in obstacles to achieving the full economic and health objectives of traditional VBC models.
For example, social determinants of health (SDoH), including safe housing, transportation, and neighborhoods; racism, discrimination and violence; education, employment opportunities and income; access to nutritious foods and opportunities for physical activity; polluted air/water; and language and literacy skills impact more than half of all health outcomes. In fact, aspects other than individual health are estimated to outweigh health-related factors in population health outcomes. A study found that sociocultural, logistical and financial factors influence medication adherence, which is a significant determinant of health outcomes.
Overcoming these barriers will require both novel VBC models and a shift in care beyond the confines of the clinic to meet patients where they are. Some public health initiatives have made significant progress in improving access, quality and cost-effectiveness of health services. For example, New York State’s 115 Medicaid Redesign Team (MRT) Waiver allows the state to implement a managed care program that provides comprehensive and coordinated health care to Medicaid recipients, thereby improving overall health care for these individuals. One component of the program, the MRT Supportive Housing Initiative, addresses housing-related SDoH by providing supportive housing to needy Medicaid participants through rental subsidies, supportive housing services, and capital projects.
A growing number of private sector organizations are developing new approaches. Here we name just a few of the growing number of companies offering care in the home or outside of the typical provider environment.
- Ounce of Care is a private-sector solution that, similar to New York’s MRT program, also provides coordinated care in affordable housing properties and includes services such as primary care referrals, Medicaid enrollment assistance, and food and utility assistance programs, etc.-on-site community health events .
- Valera Health offers telemedicine mental health services that enable patients to access medical care at the time and place they want. This significantly reduces barriers to care, which is particularly important given the growing mental health crisis in the United States.
- Aware Recovery Care brings substance use disorder services to the home, including outpatient detoxification, medication assistance and addiction treatment. This reduces both the cost of care and the quality of life of the people who need these services.
- Vesta Healthcare combines home care with primary care to better serve people with complex healthcare needs through tailored care management plans and 24/7 support. These strategies can include proactive remote monitoring of blood pressure, oxygen, weight and other metrics, allowing caregivers to recognize when health status changes and provide timely and effective interventions that can help reduce the need for hospitals and care to avoid houses and help people stay at home.
Healthcare providers themselves are also pursuing new models for interacting with the patients they care for. Mass General Brigham is deploying new patient-centered approaches that integrate virtual appointments, remote patient monitoring, meal services and in-home doctor visits. This large integrated healthcare system initially aims to convert 10% of its medical patients to this home care model.
Continuous innovation – in both the public and private sectors – is needed to increase patient engagement in meaningful ways. As individuals and governments invest in new models and initiatives, it is important to remember that patient engagement can take many forms. Meeting patients where they are (virtually, at home, in clinic) and engaging through their preferred communication channel (patient portal, in-person, digital apps) is essential to fostering productive and trustworthy patient-provider relationships crucial importance. To this end, we must recognize that patient engagement is not possible without something or someone to engage with. Both technical infrastructure and provider time are critical to supporting open communication and ensuring patients know how to engage and the benefits to themselves. Achieving this goal requires finding ways to balance patients’ access to 24/7 health care without overburdening providers and strengthening patient engagement without straining the system. Likewise, providers must be resourced to effectively engage patients. Although group training sessions offered during regular work hours work for some people, they are not an option for everyone. Engagement efforts must recognize and address barriers associated with where people live, their work schedules, their family responsibilities, and their ability to travel.
Although understanding SDoH is a good start to improving health outcomes and many companies have committed the resources (UniteUs, FindHelp, Violet Health, etc.), those at the clinic level need to be able to understand this data and process it in a timely manner and can be implemented effectively. Collaborative and coordinated engagement among providers, policymakers, advocates, payers, patients, and caregivers is the best way to achieve the patient engagement we need to make VBC accessible and effective for all.
Photo: Hong Li, Getty Images
Jason Helgerson is the founder and chief solutions officer of Helgerson Solutions Group, a healthcare consulting firm focused on helping organizations successfully transition to a values-based world. HSG works with private companies, governments and nonprofit organizations that need support in implementing value-based payment approaches and new models of care that lead to better patient outcomes and lower overall costs. HSG is also a trusted advisor to private equity and venture capital firms seeking new investment opportunities and working with companies to drive growth and profitability. Prior to founding HSG, Jason was a Medicaid director in New York. Jason led the $70 billion program for over seven years and was considered one of the most effective healthcare leaders in the country. Jason is a Senior Advisor at Windham Venture Partners. Prior to New York, Jason served as Medicaid director in Wisconsin, where he led the state’s nationally recognized Badgercare Plus program. When Jason left public service to found HSG, he was the longest-serving Medicaid director in the country.
Glen Moller is a veteran of the healthcare industry and has led health plan, provider and health services companies in both public and privately funded environments. Glen has completed several successful turnarounds and has experience leading high-growth companies in rapidly evolving sectors.
Glen was previously CEO and board member of ArroHealth, Inc., a provider of risk adjustment services and population health analytics, which he built into one of the fastest-growing healthcare companies in the country. Prior to ArroHealth, Glen served as CEO of Medicare at Centene Corporation and, prior to that, as President of Fidelis Senior Care, a PE-backed Medicare Institutional Special Needs Plan. As COO of Express Scripts Insurance Company, Glen led a Medicare program and a national prescription drug plan, now the largest in the country. He began his career at Oxford Health Plans.
Glen earned a BA in Economics and English from Boston College and an MBA from Harvard Business School. He is a member of the board of directors of Nuvem Health.