Mercer | Value-Based Care: The Data Challenge

Mercer | Value-Based Care: The Data Challenge

Health and Benefits

Value-Based Care: The Data Challenge

Employers are hearing a lot about value-based care and its potential to reduce costs, while at the same time improving care quality and patient experience. However, employers often don’t have the critical information they need to decide where or how they might take advantage of value-based care within their organizations. Fortunately, a new, breakthrough data-science approach provides a solution.

The first questions many employers have is: “Where?” Which cities or metro areas will likely provide the greatest return on investment for value-based care? Some markets have more clinical problems than others do—higher-than-average C-section rates or hospital re-admissions, for example. So if employees in those areas can be steered toward the providers that most effectively deliver value-based care, employers have an opportunity to see substantial improvements in cost, quality, and patient experience.

Because value-based care can vary a great deal from one market to the next, employers need to evaluate the potential benefits at a local level. Most employers, however, don’t have the HR resources to do such a detailed market-by-market analysis. Knowing how to obtain the information they need to decide where they might participate in value-based care has been one of the greatest barriers to adopting this model.

Health care is practiced locally, and so solutions must be local as well.

In addition, simply knowing which markets have the most clinical problems is not enough. Employers also need to determine which physician groups, hospitals, and other providers within those markets are the most successful at delivering value-based care—rarely an easy task. Any provider can call itself a value-based health care organization or an accountable-care organization. The trouble is there are no clear and consistent definitions for either term. In fact, many providers across the country have entered into value-based care contracts before putting the necessary infrastructure in place.

How do employers navigate these many complexities? 

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