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Value-based care shift hits inflection point with tech and policy advancements

June 18, 2021
Business Affairs
Rich Whitney
By Rich Whitney

The healthcare industry in the U.S. has spent a whole generation talking about moving from a fee-for-service to a value-based model, focusing more on improved patient outcomes and early interventions rather than disease treatment. This shift has occurred gradually, sometimes purposefully, and sometimes in fits and starts, but overall, it has been slower than expected. Nowhere is this more apparent than in the chronic kidney disease (CKD) patient population. What makes now different?

Since March 2020, the coronavirus pandemic has laid bare fissures in healthcare’s firmament, especially related to its most vulnerable populations. The silver lining is that the crisis has also sped the confluence of multiple factors – such as improved technology, changing federal regulations and increased care coordination – that are helping us smooth the cracks, making this the perfect time to accomplish some of the positive changes we’ve been working toward for decades.

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Using tech to manage populations and multiply skills
Today, technology makes it possible for us to manage populations at scale that would have been much more difficult in the past. This momentum will continue with the creation of more big data and artificial intelligence (AI) systems helping to automate tasks that, not long ago, had to be done manually.

AI solutions ingest data on populations and help clinicians make predictions about which patients would benefit most from interventions. The technology acts as a skill multiplier for care providers, helping them monitor patients and identify warning signs sooner than would be possible unassisted.

Tech boosts care coordination
The healthcare system is not set up to coordinate data outside silos, and we are trying to change that across the entire continuum. There are several hurdles, including regulatory constructs, reimbursement incentives and more. A huge part of the solution is using technology to aid in care coordination between normally siloed departments and people, with AI and other technology tools driving insight and actions from data that would otherwise be difficult to recognize, as well as facilitating more seamless communication and critical information sharing.

Care coordination is a broad label for what needs to happen across all of healthcare, especially among acute patient populations that are complex, high risk and costly. This is one of the best places to start.

As an example, we can look at how this inflection point is impacting some of our most vulnerable patients: those suffering from CKD, which impacts 37 million Americans, most of whom are unaware they have it. Many CKD patients are currently receiving care, medications and interventions across multiple different providers, without care being coordinated in a meaningful way.

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