As of 2022, over 62 million people — nearly a fifth of Americans — are enrolled in Medicare, and just under 40% of those individuals take part in Medicare Advantage plans.
Medicare Advantage patients pose a unique challenge to healthcare payers due to their age and high rate of comorbidities; nearly 80% of Medicare Advantage patients have two or more chronic conditions, and 60% have three or more. While traditional insurance operates under a fee-for-service model in which providers are paid for service rendered, Medicare Advantage utilizes a value-based care approach. Under this model, providers are paid depending on the outcome of the service provided — it’s about quality, not quantity.
There are many benefits to taking a value-based care approach to patient management, especially for plans that support many patients with chronic conditions. However, implementing such an approach is a massive task for both payers and providers. This blog post will explain some of the challenges payers and providers face with value-based care and how using a customer relationship management (CRM) solution like Salesforce’s Health Cloud can help.
Value-Based Care Poses a Challenge to Payers and Providers
While there are many benefits to deploying a value-based care approach, it — like anything nontraditional — poses a few challenges for payers and providers.
Under the value-based care model, a patient's entire medical team must be connected and have access to the most detailed and up-to-date information on an individual's condition. As Jim Rogers, RN, Gerent's Senior VP of Healthcare and Life Sciences, noted in our recent white paper, value-based care is all about proactively engaging with patients and providing timely, personalized care.
“[It] requires payers and providers to engage with patients outside the bounds of a traditional health care visit," Rogers said. "They need to offer virtual visits and coaching, home-based services, home monitoring devices, etc., rather than waiting for the patient to end up in the ED. You need to start changing how you care for and engage with a patient; it becomes a journey rather than a series of episodic events."
Many healthcare organizations simply don't have the time or resources to provide comprehensive, coordinated support to their patients. For example, suppose a patient has diabetes and needs to visit the emergency room. In that case, the ER doctor may find it helpful to see the patient's records from their endocrinologist to provide more background. However, with the way electronic health records (EHR) systems are structured, this is not always possible.
Sharing patient data between doctors, insurance companies, and other specialists was a relatively uncommon practice until recently.
According to a survey by the College of Healthcare Information Executives (CHIME) and KLAS Research, the number of providers surveyed who said they could access information stored in EHR systems different from their own went from 28% in 2016 to 67% in 2020. Moreover, EHR systems are only one way in which providers store patient data; many other storage locations (e.g., wearable data, nonclinical notes, etc.) are inaccessible to individuals outside of the recording organization.
To put the matter simply: if a care organization relies on an antiquated digital system, it may not have the interoperability or functionality necessary to facilitate effective value-based care.
How Salesforce Health Cloud Can Facilitate Value-Based Care
Both healthcare providers and payers can use Salesforce Health Cloud to help improve patient experiences and streamline the care coordination process. With Health Cloud, all patient data is consolidated in one place, making it easier for specialists from different departments to access and share information with their patients’ other doctors. Health Cloud also gives providers the ability to:
- Create personalized communication journeys (teams can send and receive messages to and from each other and the patient)
- Create custom care plans with attainable goals for patients
- View open cases and tasks with prebuilt workflows
- Find providers for patients based on specialty and location
- See a patient’s entire care team on their profile
- Incorporate third-party data from devices and wearables like FitBits or glucose monitors
- Integrate data from electronic health records
Providing efficient and effective value-based care experiences to Medicare Advantage patients requires a lot of coordination. With Salesforce’s Health Cloud, that process becomes streamlined, empowering providers and payers to focus on what’s most important — helping patients.
To learn more about how Salesforce can help your team effectively implement a value-based model, contact Gerent today! For more information about value-based care and Medicare Advantage, download our white paper, Reimagining Medicare Advantage: The Value-Based Care Challenge (and Opportunity).