MOBE | How to maximize value in the payer-provider model.

How to Maximize Value in the Payer-Provider Model

By: Chris Cronin, Chief Executive Officer

“In healthcare many times we try to boil the ocean—it’s much easier to focus on how we can just boil the water in a single pot.”

These words from Troy Simonson, CEO of Twin Cities Orthopedics, really resonated with me during a recent Relevant Health Roundtable panel discussion – and in this unpredictable year, they are especially meaningful. COVID-19 has revealed the depths of the cost-of-care crisis and highlighted the importance of evaluating – and reimagining – the payer-provider business model. Over virtual coffee, Troy, Susan Knudson, Rajat Relan and I discussed where the value lies in this model and how we can make a true impact. The bottom line? We must adapt to the changing landscape in a focused way that makes a difference for both individuals and the health system as a whole.

During the past eight months, we all have seen COVID-19 place unprecedented changes and challenges on the healthcare system. From a decrease in in-person doctor visits to triaging COVID-19 care, every aspect has been put to the test. Identifying the most valuable services – and most effective ways to deliver those services, accounting for both individual access and the role of social determinants of health – is key for protecting public health during this pandemic and beyond.

Here are three critical learnings I shared during the roundtable that we must apply to help our system work better for more of the people it seeks to help.

Focus on a population that needs the most help.

Data show that more than 83MM Americans are managing two or more chronic conditions that require frequent and recurring health care, comprising more than 1 in 3 Americans. But to Troy’s point about not trying to boil the ocean, there are certain people among this population who aren’t getting better – despite investing time and money into their own health and participating actively in the healthcare system.

The MOBE 2020 Chronic Care Action Index found that 56% of healthcare providers see their patients with multiple chronic conditions at least bi-monthly, yet 76% of people with multiple chronic conditions report their health hasn’t improved in the past year. We focus on identifying this specific, smaller, “hidden population” to provide one-to-one support that helps bridge the gap between doctor’s appointments and daily life.

In fact, the pandemic has exacerbated the need and desire for a solution like ours. Since March, our engagement rates have risen by 50%. With increased COVID-19 risks facing people with chronic conditions, reaching these individuals can make lasting and enduring impacts on an individual’s health.

Address health for the whole person.

To help individuals improve their health, any wellness-focused solution must address all of the facets of a person’s health and tailor their guidance to be specific to that individual. Addressing medication, nutrition, fitness, and other factors impacting wellness like sleep and mental health help an individual understand their entire health picture and implement changes that work for them specifically. The Chronic Care Action Index also found that exercise (51%), eating healthier (40%) and getting more sleep (38%) were the changes individuals most wanted to make in relation to their health but found most difficult to make. In fact, one-third of respondents (29%) said it’s hard for them to feel motivated to follow their doctor’s guidance – a challenge even more common among people managing multiple chronic conditions (38%). When a program provides continued motivation and support, and uncovers the interrelatedness of an individual’s health challenges, it drives change and better health outcomes.

Embrace the benefits of telehealth.

As Susan Knudson, Chief Informatics & Health Engagement Officer at HealthPartners said, “Virtual visits are here to stay and they are changing the experience.” In this day and age, everyone is on their phone, computer, or other smart devices and expects their healthcare to be as easily accessible as their other day-to-day interactions. People want support when and where they need it. Whether via video chat, text, phone, or otherwise, it is crucial to make connecting easy and natural.

As we move forward during this pandemic and beyond, we have the opportunity to identify issues and improve our health system in real-time. All of us in healthcare – from doctors, nurses, pharmacists and dieticians to industry scientists, engineers and app developers – are in this line of work because we care about helping people be healthier and happier. Finding ways to ensure that we are all working in concert to improve people’s health and lives – and that people have the information and support they need in order to apply the lifestyle and medication guidance they receive – is the key. One pot of water at a time, we can boil that ocean.

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