By Rob Kream,
Vice President and General Manager of Provider Development,
Elevating the patient experience has been a guiding principle of value-based care since the concept emerged as one of three pillars supporting the much-publicized Triple Aim framework for health care reform in 2007.
In the years since, efforts designed to strengthen the patient experience have largely focused on improving quality and enhancing patient satisfaction both during and after care is delivered. Now, a growing number of health care organizations are broadening the scope of their efforts to improve the patient experience at its earliest stages. Some are introducing tools that assist patients as they decide how they’ll pay for and gain access to future medical services.
As value-based and accountable care models gain traction across the country, providers are increasingly turning to third parties to help their patients find the optimal health insurance plan for their financial and medical needs, while supporting their own ability to enhance patient engagement and the quality of care they deliver.
Now more than ever, insurance coverage has a direct bearing on whether, and to what extent, a patient can follow the treatment plan prescribed by their health care provider. As the shift away from fee-for-service care accelerates, frequent changes in plan design and provider networks may prevent patients from accessing a longtime clinician or a recommended facility, pharmacy or service. Such changes often trigger dramatic increases in out-of-pocket expenses. Many Medicare enrollees already struggle to keep pace with the cost of care. A 2016 study by the Commonwealth Fund found that nearly a quarter of the nation’s 11.5 million Medicare beneficiaries were underinsured and paying an inordinate percentage of their income on health care.
For providers, these kinds of disruptions undermine their ability to support continuity of care for their patients, and expose their organization to financial penalties associated with poor performance in at-risk contracts. This is particularly true with Medicare Advantage plans, which increasingly, are structured to incentivize quality improvement and reduce unnecessary utilization – both of which are at the core of value-based care.
A trusted advisory solution
Mitigating coverage pitfalls for both patient and provider is the goal of a new class of solutions aimed at helping Medicare beneficiaries make the best possible insurance choices during annual open enrollment. It’s true that hospitals and health systems have neither the expertise nor legal authority to offer patients direct assistance when it comes to helping them make coverage decisions. However, co-branded solutions delivered by a vetted third-party broker and carrying the hospital’s endorsement represent a powerful and trusted resource providers can recommend to their patients.
These arrangements connect patients with insurance professionals who harness advanced analytics and online tools to help Medicare beneficiaries sort through increasingly complex and often-confusing plans, features and price points. While brokers have long played an advisory role in health plan selection, advances in automated coverage algorithms and analytics now enable far greater precision when it comes to aligning a patient’s medical and financial circumstances with the most appropriate plan.
Nationwide, a growing number of provider organizations are recognizing the benefits that flow from incorporating Medicare coverage assistance into their efforts to improve the patient experience. eHealth Inc., a leading online insurance exchange, recently partnered with a half-dozen health systems to provide Medicare-eligible patients with the tools and expertise necessary to maximize their coverage and sustain continuity of care.
As providers advance further down the path of value-based payments, it will become increasingly important for consumers to understand how to access the health care system and stay connected to their care team. Providers and payers must manage costs and quality more effectively. By utilizing third-party advisors and new technology-based tools all three constituencies – patients, providers and payers – are able to align in new ways that bring value to all.
Robert Kream is Vice President and General Manager of Provider Development at eHealth, Inc. (eHealth.com), which is based in Mountain View, California. Mr. Kream has worked in the healthcare and insurance industries for more than twenty years, with a primary focus on business growth and the development of value-based partnerships that better serve the needs of providers and consumers.