As noted in the first article in this series, traditional value-based (VBC) care models are largely focused on economic incentives to healthcare providers and facilities. Many VBC organizations lack the infrastructure in place or scale to integrate factors that impact how patients interact with the healthcare system, engage with care providers, or adhere to treatment recommendations. Failure to consider and address these needs can create obstacles to realizing the full economic and health goals of traditional VBC models.
For example, social determinants of health (SDoH), including safe housing, transportation, and neighborhoods; racism, discrimination, and violence; education, job opportunities, and income; access to nutritious foods and physical activity opportunities; polluted air/water; and language and literacy skills, impact more than half of all health outcomes. In fact, it is estimated that aspects other than individual health exceed health-related factors with respect to driving population health outcomes. One study found that sociocultural, logistical, and financial factors impact medication adherence, which is a key driver of health outcomes.
Overcoming these obstacles requires both novel VBC models as well moving care beyond the clinic walls to meet patients where they are. Some public health initiatives have made significant strides toward improving access, quality, and cost-effectiveness of health services. For example, New York State’s 115 Medicaid Redesign Team (MRT) Waiver allows the State to implement a managed care program that provides comprehensive and coordinated health care to Medicaid recipients, improving these individuals’ overall health coverage. One component of the program, the MRT Supportive Housing Initiative, addresses housing-related SDoH by providing supportive housing to high-need Medicaid participants through rental subsidies, supportive housing services, and capital projects.
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A growing number of private-sector organizations are innovating new approaches. Here we name just a few among a growing number of companies that are delivering care in the home or outside the typical provider setting.
- Ounce of Care is a private-sector solution that, similar to New York’s MRT program, also provides coordinated care within affordable housing properties and includes services such as referrals to primary care, support in enrolling in Medicaid and food and utility assistance programs, and on-site community health events.
- Valera Health provides telemedicine mental health services that allow patients to access care at the time and place of their convenience. This greatly reduces barriers to care, which is especially important given the growing mental health crisis in the United States.
- Aware Recovery Care brings substance use disorder services, including ambulatory detox, medication assistance, and addiction treatment into the home. This both lowers care costs and improves the quality of life for individuals needing these services.
- Vesta Healthcare connects home care with primary care to better serve individuals with complex health needs using tailored care management plans and 24/7 support. These strategies can include proactive and remote monitoring of blood pressure, oxygen, weight, and other metrics that allow care providers to know when there is a change in health status and to provide timely and effective interventions that can help obviate the need for hospitals and nursing homes and help people stay at home.
Care providers themselves are also pursuing novel models for engaging with the patients they serve. Mass General Brigham is deploying new patient centricity approaches that integrate virtual appointments, remote patient monitoring, meal services, and in-home clinician visits. This large integrated health system has an initial goal of moving 10% of its medical patients to this in-home care model.
Continued innovation— in both the public and private sectors — will be needed to increase patient engagement in meaningful ways. As individuals and governments invest in new models and initiatives, it’s essential to remember that patient engagement can come in many forms. Meeting patients where they are (virtual, home, clinic) and connecting through their preferred communication channel (patient portal, in-person, digital apps) are critical for facilitating productive and trusted patient–provider relationships. Toward this end, we must acknowledge that patient engagement is not possible without something or someone with which to engage. Technical infrastructure and provider time both are essential for supporting open communication and ensuring that patients know how to engage and the benefits to themselves of doing so. Achieving this goal requires finding ways to balance patients’ 24/7 access to care without overburdening providers and to empower patient engagement without straining the system. Similarly, providers need to be equipped with resources to effectively engage patients. While group education sessions offered during regular working hours may work for some people, they are not an option for everyone. Engagement efforts must acknowledge and address barriers associated with where people live, their work hours, their family responsibilities, and their ability to travel.
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Finally, while understanding SDoH is a great start to improving health outcomes and many companies have put in the resources to do so (UniteUs, FindHelp, Violet Health, etc.) those at the clinic level need to be able to understand these data and make them actionable in a timely and effective manner. Collaborative and coordinated engagement among providers, policymakers, advocates, payers, patients, and caregivers is the best way to achieve the patient engagement we need to make VBC accessible to and effective for all.
Photo: Hong Li, Getty Images
Jason Helgerson is the Founder and Chief Solutions Officer for Helgerson Solutions Group, a health care consultancy firm focused on helping organizations successfully transition to a value based world. HSG works with private companies, governments and non-profit organizations that need assistance in implementing value-based payment approaches and new care models that will lead to improved patient outcomes and lower overall costs. HSG is also a trusted advisor for private equity and venture capital firms as they look for new investment opportunities and work with companies to drive growth and profitability. Prior to founding HSG, Jason was New York’s Medicaid Director. Jason ran the $70 billion program for over 7 years and was recognized as one of the nation’s most effective healthcare leaders. Jason is a senior advisor to Windham Venture Partners. Prior to New York, Jason was Wisconsin’s Medicaid Director where he led the state’s nationally recognized Badgercare Plus program. When Jason left public service to found HSG, he was the nation’s longest standing Medicaid Director.
Glen Moller, CEO of Upward Health, is a veteran of the healthcare industry, having led health plan, provider, and health services businesses in both public and privately-funded environments. Glen has managed several successful turn-arounds and is experienced leading high growth companies in rapidly evolving sectors. Glen was previously CEO and Board Member of ArroHealth, Inc., a provider of risk adjustment services and population health analytics that he led to became one of the fastest growing healthcare companies in the nation. Prior to ArroHealth, Glen served as Medicare CEO at Centene Corporation, and before that as President of Fidelis Senior Care, a PE-backed Medicare Institutional Special Needs Plans. As COO at the Express Scripts Insurance Company, Glen led a Medicare program and national Prescription Drug Plan, now the largest in the country. He started his career at Oxford Health Plans. Glen earned a B.A. in Economics and English from Boston College and an M.B.A. from Harvard Business School. He serves on the Board of Directors of Nuvem Health.
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