The topic of value-based care in health and wellness has been making waves for some time. The system, which awards providers based on prevention and health outcomes instead of a traditional fee-for-service model, brings personalization to the forefront of the healthcare relationship.
The value-based care approach received an enormous tailwind with the January 2018 announcement by Amazon, Berkshire Hathaway, and JP Morgan Chase of a partnership to form an independent health care company for their combined 1.2 million employees. The intent is to explore a system focused on creating value free from profit-making incentives and constraints.
Value-based care adopts a “Triple Aim” approach of providing better care and better overall health outcomes at lower cost. One of the biggest opportunities is the roughly 70 percent of healthcare costs that are influenced by consumer behaviors, whereby payers and providers are incentivized to help consumers address those behaviors. Helping a patient with a chronic condition such as Type 2 diabetes manage a diet and exercise regimen, for example, can reduce medication intake and long-term costs while also improving the overall wellness for that patient.
Change Healthcare estimates that by 2021, 75 percent of payments in healthcare will have a value-based care component. Making in-roads to a value-based care approach requires providers and payers to establish deeper relationships with the consumer, which is a large part of the reason why the recent announcement triggered such enthusiasm.
Amazon has long been a disruptor in personalizing customer experiences using data and analytics, and there’s genuine excitement to see what transpires when it applies this expertise to the healthcare space. The new partnership will have plenty of company in the race to disrupt the industry with value-based care innovations. Oliver Wyman Health, for instance, anticipates that there is $500 billion opportunity for disruptors to create the best customer experience and become a new “front door” in healthcare.
The Personalization Factor
Mounting interest in value-based care intersects perfectly with both consumers’ rising expectation for personalized experiences and an abundance of smart devices and other technologies that help an always-connected consumer be stewards of their own health. Many smartwatches, for example, provide users with a mobile app dashboard with real-time and aggregate health metrics that we used to only get at a yearly physical, including resting and active heart rate, an activity log, exertion statistics, calorie intake, and sleep patterns. A payer or provider with metrics from a Type 2 diabetic’s smartwatch could use it to customize an exercise plan, send timely reminders, congratulatory notes, or other engagements to help change behavior.
Data drives the consumer expectation for personalization; we provide data with every purchase we make and every online search we conduct, and we expect the companies and brands we do business with to use it to provide us with relevant, timely experiences.
Personalization also works in changing behaviors. In one smoking cessation study, subjects who received tailored health content were more than twice as likely to have abstained from smoking at a 12-week follow-up than subjects who received generalized content. With so much data available through mobile, social, web, email, call centers, and connected devices, the consumer expects payers and providers to know their health history and patterns. Furthermore, consumers have more choices in healthcare than ever before, and the consumerization of healthcare makes it critical to meet these increasing customer expectations for personalization and exceptional service.
An IntelliResponse survey measuring the state of customer service revealed that health insurance tops the list of industries where Americans expect the highest level of customer service accuracy, with 54 percent of respondents selecting health insurance as the most important for accuracy – nearly four times higher than utilities, which ranked second at 14 percent. Additionally, 58 percent of respondents said they would consider switching health insurance if they had a poor online customer service experience.
A Single View of the Healthcare Consumer
The winners in the race to value-based care will be payers and providers who establish the deepest level of understanding and engagement with individual consumers. This approach recognizes claims data and clinical data as just a fraction of data useful to drive insights. In prioritizing behavioral and third-party data, payers and providers must re-imagine every aspect of how they’re engaging with the consumer. The business processes, technology, and delivery models need to all support putting the customer first.
Often, data and engagement silos stand in the way of this goal. Most organizations have multiple engagement systems, and few say that they possess a complete view of the customer from all their available data sources. A solution that links all first-party, second-party, and third-party data sources to create a unified view of the customer is the first step to engage with the customer.
With a single customer view, Redpoint Global clients in the healthcare space are making the transition to value-based care by developing analytic-driven processes and programs. These include tracking patients outside of provider or clinic visits, rolling out multichannel marketing programs, and supporting care selection from a network of personalized services such as home health, social care, transportation, and telemedicine offerings.
Innovations are made possible when you have a single point of control over data, decisions, and interactions. Behavioral data is not only different for every consumer, it’s also defined by constant change. Advanced capabilities that include in-line analytics and machine learning (ML) make it possible to respond to an individual consumer with relevance in the context of those changing behavior patterns. A single point of control ensures that these next-best action recommendations will always be performed in the cadence of the customer.
Payers and providers know that they need to move beyond general population health, and value-based care now provides an extra incentive to develop a deep relationship with each consumer through a personalized experience. Fee-for-services systems and the associated simple segmentation by age, gender, and risk factor fall short of producing the types of outcomes the market now demands.
Value-based care recognizes that we need to get more out of our investments in healthcare given the rising costs and uncertain outcomes. Personalized consumer engagement that accounts for changing behaviors is one of the more effective ways to accomplish the Triple Aim goals of better care, better outcomes, and lower cost.
