There's been a lot of conversation around value-based care (VBC) models, and payers, providers and biopharma – each have their own take on what VBC means to them. But lately there has been more conversation around patient-centered care and what that looks like through the lens of a value-based approach.
Value-based care – paying for outcomes as opposed to a fee for service or procedure – has been growing in recent years. A recent report found that the percentage of healthcare payments tied to value-based care reached 34 percent in 2017, up 23 percent from 2015, and affecting approximately 226 million Americans.
The combination of increased access to data, more powerful computing power and rapid advances in health and medicine presents a unique opportunity to meet the goals of value-based care. The economic component involved is crucial which is why the first step in treatment is determining the best option for an individual patient. Identifying the right intervention sooner means that patients can avoid undergoing ineffective, costly care (a significant tenet of value-based care). Data and algorithms are being employed more than ever to match the right patient to the right treatment. And it would appear that the timing couldn't be better.
The time is now
The convergence of interventions, data expansion and improved AI/machine learning power provides the table at which payers, providers and pharma can come together together and align on the singular goal of best care for the individual patient.
There are several examples of where this is working. Geisinger, one of the nation’s most innovative health services organizations, has started to reimburse its members for food as medicine, and then tracks their members health to understand the impact of healthy food. Blue Cross Blue Shield has also unveiled a nationwide program to combat disease via food. Ochsner Health System uses wearables data to monitor key health indicators and make decisions about care management. On the therapeutic side, gene therapy, next generation disease modifying treatments, and immunotherapy are all examples of innovative interventions. The interventions delivered feed back into growing data streams to bridge the gap between the clinical setting and the home.
The depth of data available therefore presents the opportunity for further intervention optimization. Not only can we, for the finally review a patient’s entire genome and molecular readouts on any level where we think there might be a signal from proteomics or lipidomics, but this information can be paired with data from existing intervention approaches. We can integrate these data modalities and apply machine learning and AI to model underlying causes of the person’s disease and health trajectory in response to treatment.
Using computer modeling to document patient responses to various therapies reduces the guesswork in trying to find the right treatment. Instead we can use the models we’ve created to run simulations to analyze different scenarios and determine the optimal treatment and intervention for an individual patient.
Real world impact
The ability to look at longitudinal health records including genomic and treatment data for specific diseases offers a window into line of treatment decisions. This type of analysis is game changing because these insights can enable clinicians to develop more informed treatment plans for patients, personalized to their genetics and likelihood of response. Pharma companies can use this data to better understand the mechanistic underpinnings of disease and advocate for more informed formulary placement based on patient subgroups’ response to treatment. The models can also provide payers with the input they need to determine appropriate reimbursement.
It is well known that the rising cost of healthcare is unsustainable, which is why VBC was developed. We simply need to deliver care at a better cost in order to sustain healthcare as we know it. Equally important, patients should be able to receive the care that is going to work best for them as individuals with unique genetic make-ups.
At the core of VBC is paying for successful health outcomes. We know have the tools to support this vision by better understanding why treatments work for some and not others - enabling us to match the right treatment to the right patient. This type of matching is the formula for better health outcomes - which truly a win for everyone.
 Healthcare payments tied to value-based care on the rise, now at 34 percent, by Jeff Lagasse, Health Finance, October 24, 2018.