When people need healthcare, they need to receive it in a way that is optimized. Optimization encompasses many things—not only delivering the appropriate care to help patients get healthy, but also finding the organizations and care providers that will provide the shortest path to success for the desired patient outcomes. When there is an intersection between the right care at the right time with the right organizations reaching the right patients, the experience and efficiency of care is optimized, and you take a major step toward Healthcare Solved.
For healthcare to be solved, it must not only be optimized for patients, but must also be sustainable for those that provide care. This is where value-based care sometimes struggles. In a fee-for-service world, there is a clear path to compensation—a provider performs a service for a given fee and gets paid. With value-based care, providers abandon this clarity for a riskier path, and bet that the cost of the care they provide will be less than the (often capitated) compensation so they will have a profit. This care model requires more of providers. Not only do they have to deliver the service, but they also must understand and manage the extent to which the patient needs more services—and whether the patient is doing the right things when they walk out the door. If the patient comes back because the issue hasn’t been resolved, it will add to the cost and reduce the organization’s profitability. It is a more challenging environment to operate in.
The only way to be successful is to create a balance between profitability and outcomes in which the providers, the payers, and the recipients of care all win. In this scenario, some of the responsibility shifts from the patient to the provider, who takes on care coordination outside a single care setting and makes sure all the care comes together to benefit the patient. At the same time, payers must provide an attractive benefit to attract and retain members in their plans, and yet be able to profitably underwrite the true expense they pay out to providers. This may mean shifting risk through payment caps or offering incentives for services that may limit total costs, or through deductibles and coverage limitations.
For this model to be sustainable, the costs and burden need to be shared, finding a middle ground that distributes the risk and reward and work not just among payers, medical providers, and care recipients, but also among different types of providers that address social determinants of health. The challenge is striking the right balance so patients get the care they need and providers and payers can be profitable.
This vision is bigger than a single entity can deliver—by definition, it’s a group effort. GSI Health is committed to doing our part, addressing the central tenants of population health management by creating a tool that reduces friction across organizations, making it as easy as possible to manage care across diverse providers and settings. We help organizations hone their experience via analysis and identifying patterns so that they can gather insights on how to improve, then infuse those insights back into the care model. Keeping care coordination and analytics close together enables organizations to embark on a continuous cycle of improvement to improve efficiency and outcomes so that providers and managed care organizations can keep their populations healthy while achieving their business goals.
Having a tool that enables true population health management is only part of the picture. Organizations also need to change their workflow to ensure that care coordination extends beyond their own four walls. It takes a village to tend to a patient wherever they go—which requires a change in how providers do business, and the adoption of progressive methodologies and workflow. Payers need to give providers who are willing to make that shift to value-based care enough of an incentive or reward that it can be profitable. And, the patient needs to consent to be part of these programs and accept the mindset of team-based care, including sharing healthcare information so that all providers can do their best for the patient.
Solving healthcare is a multifaceted problem, and everybody has a role to play. Today’s alignment of political will, economic pressure, and technology advancements, combined with the spotlight on healthcare, create a unique opportunity for us to make real strides toward optimizing healthcare delivery and achieving Healthcare Solved.
GSI Health will do its part.