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Healthcare organizations have been on a long, winding road to value-based care, but the promise of improved patient outcomes and reduced costs is nearing as value-based care gains traction.

Existing claims and clinical workflow-based legacy technology investments, both on the payer and provider sides, simply are not equipped to efficiently administer value-based arrangements at scale.

As more payers and providers implement value-based care (VBC), treatment increasingly is shifting to a patient’s home or community setting. For payers, integrating community-based organizations (CBOs) into traditional care networks offers both an opportunity and challenge.

The growing popularity of value-based care (VBC) reimbursement models is driven by the desire to improve patient outcomes while lowering health care costs for providers and payers. Among the latter group are employers that either provide health insurance to employees through a health plan or self-funding.

Even the highest-quality medical care cannot overcome all of the factors patients encounter that lead to poorer health outcomes. One highly cited study attributes 81% of outcomes to socioeconomic factors and health behaviors and just 16% to clinical care.

The transition from treating patients at a provider’s site to delivering care in the home and community requires two things: an ability to incorporate social determinants of health into the care coordination process and the inclusion of value-based care and community-based organizations as compensated care delivery partners in value-based care networks.

The tepid relationship between health equity and value-based care became all too real during COVID-19. Vulnerable populations were severely impacted by the pandemic, resulting in higher infection rates and deaths.

Unlike traditional fee-for-service healthcare, VBC emphasizes keeping people well over “sick care.” As a holistic approach to healthcare, VBC can leverage social determinants of health (SDoH) to develop individualized care plans and to inform population health strategies.

To fully leverage SDOH information and provide more complete services throughout the care continuum in support of value-based care, payers should include community-based organizations (CBOs) in their value-based care network contracting strategies. Doing so creates a broadened, higher performing set of resources to keep people healthy and at home.

Value-based administration for whole health in the home and in the community is what we do at HSBlox.  It's about leveraging social determinants of health (SDoH) to implement value-based care. True and successful value-based administration operationalizes the value-based care continuum of capabilities that exist where value-based care and precision health intersect to create value-based plan design.

Historically, the U.S. healthcare system has evolved based upon the presence of an “event”, i.e., the need for a visit – planned or impromptu – to a medical provider and/or facility. The inefficiencies, glut of utilization and exponentially rising costs that flow from it as funded by the long-standing “fee-for-service” (FFS) payment methodology have been well chronicled to date. Even with the advent of a variety of risk-share payment models, medical costs remain out of control due to the complexities of operationalizing such models across a heavily siloed healthcare continuum.

The global population health market is expected to reach $91.4 billion by 2026, up from just $21.4 billion in 2018. Those in the health care trenches understand that this is due primarily to the growing shift from fee-for-service reimbursement to value-based care. As providers and payers move deeper into population health and value-based case, one thing is clear—they need to be much more strategic in how they tackle social determinants of health (SDoH). They need to have a new look at broader industry partnerships and programs, as well as advanced technology solutions. 

There’s a growing awareness among employers, community advocates, and the public health sector that issues of diversity, equity, and inclusion (DEI) must be addressed in the healthcare ecosystem if we are to implement genuine value-based care (VBC).

The healthcare industry does a lot of things right, but it has struggled to influence the social conditions, behaviors, and daily activities occurring outside medical facilities that directly impact the health and well-being of patients and plan members. By integrating the episodic care and SDOH platforms, providers and payers have both a comprehensive view of the individual and resources that allow them to impact behaviors at the street level.

It has been clear for years that social determinants of health (SDOH) – factors such as education, economic and housing stability, community support, and access to transportation – have a disproportionate impact on health outcomes. Research shows that SDOH accounts for up to 80% of health outcomes, while medical care – which costs the U.S. nearly $4 trillion annually – accounts for the balance.

Providers and payers need data to address social determinants of health effectively. But that data is often siloed, unstructured and difficult to use.

If payers and providers could leverage a comprehensive medical and social longitudinal health record (LHR) that includes SDOH data and enables them to connect patients with community support resources, they could reduce healthcare costs while improving lives. Such an approach would make SDOH data securely available to clinicians at the point of care, giving them a holistic view of the patient.