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Managing in a Maelstrom: Fishing for Focus and Value

by Janice Young | April 27, 2017

Healthcare market attributes, context, policies, administration, payment and scope have been hotly debated since the inception of insurance programs nearly a century ago. Despite constant change, the market organization and investment targets were generally guided by reasonably clear directions and mandates, including most recently, EHR execution, ICD-10 implementation, consumer driven care, healthcare exchanges.

Technology evolution and investment has marched on in similarly iterative waves: interoperability, EHR, analytics, consumer technologies, population health management. The industry is accustomed to change, but also accustomed to clearer objectives. It is worth noting that all these are broad brush strategies applied universally. The tacit hope that each is the newest silver bullet to solve the ills of healthcare and that the “firehose” approach will wash away all problems.

The current wave of change in 2017 is completely different. In a recent conversation on the emerging provider payer convergence model, the market was described as “everyone is swiveling into value.” And, in the value based market, not only are there no clear guideposts, but no clear business models.

Simultaneously, every model and every product is now “value based” as every vendor markets under value based themes.

The definition of “value based” itself is all encompassing, from reimbursement strategy to product design to population health management, to quality care and metrics to consumer engagement to consumer satisfaction. And, the long(er) term existence of any models or definitions, old or new, are uncertain as federal and state mandates and financing ebb and flow.

The market reflects more a maelstrom than a transition.

Making business and technology decisions amidst the maelstrom of 2017 is not like making business and technology decisions amidst the defined change of 2000. The question then is how to make technology and business investments as durable as possible in highly volatile market conditions. A few observations from recent discussions:

It’s the data.

While this is an old theme; it can’t be restated often enough. One thing every model – past, present, anticipated future – includes is shared data for better information sharing. No matter the reimbursement system, the care or population health management model, consumer engagement strategies – the success of any model rests on strong underlying data and a platform upon which to share it (across stakeholders) and build analytics, workflows, applications and programs relevant to the healthcare business model of the day. investment in any related technology without an underlying data and information management strategy will limit the return on any investment. Without it, there is no way to credibly negotiate a contract, assess risk, manage a population, identify the highest quality cost effective care strategy, engage a consumer, report quality. This is currently Chilmark’s underlying construct for provider payer convergence.

It’s the (services) partner.

I and other colleagues at Chilmark have noted the rise of the services markets, notably in provider payer convergence initiatives, convener, population health and analytics markets. Services markets flow in times of uncertainty and rapid change. The current maelstrom has ignited rapid growth in multiple technology sectors that is remarkable even for the health care industry. Uniquely in this round, services organizations are positioning more as business partners, taking on risk and acting in many cases on behalf of their contracting organizations. The business and risk relationships are rapidly evolving from a provider payer relationship to a provider-services partner-payer relationship.

It’s the case study.

Let’s be honest. In the maelstrom, no one quite knows what works. Population health strategies that were marginally effective for years within healthcare payer organizations are being transplanted to at risk provider organizations, And, what works in one environment with one risk/reimbursement, provider network, clinical and population health model may well not work as well in another. Market heterogeneity in business, operations and technologies is getting worse, not better.

How to move ahead?

Each healthcare organization has a different market, population, business, technology and maturity with different initiatives. The goals are no longer broad and lofty – an EHR implementation, standing up an ACO or building a patient portal. In a maelstrom, the firehose approach doesn’t work and hopes that cost and quality can be affected this way are rapidly subsiding across the industry. Successes will come from using information, partnering to gain expertise and reduce risk and using technology, business and operations resources to improve health one focused issue and opportunity at a time.

Stay up to the minute.

“As biometric data becomes cheaper and easier to collect through smart sensors, devices, and mobile apps, expect to see more innovations in consumer health.”

-Alicia Vergaras