“Fee-for-service” health care will soon be left far behind if insurance companies like United Healthcare (UHC) are guiding the delivery system, according to Daryl Richard, UHC’s vice president of corporate communications, who spoke recently at Sacred Heart University’s new Center for Healthcare Education.
Dozens of health profession students and faculty and members of the university community were on hand for Richard’s talk, “Value-Based Care at the Community Level,” which was sponsored by SHU’s College of Health Professions. Dean Patricia Walker introduced the speaker.
Richard, a self-described “reporter by trade and storyteller” with a strong media background and not at all an actuary, set out to achieve three things in his talk: define value-based health care, characterize it at the local level and relate it to the student experience at SHU. In describing the old delivery method of health care, he related the story of his wife’s asthma attacks in fall 2008 and how she moved through the system, from the emergency room to a primary-care doctor and then to an allergy specialist. The doctors performed redundant tests, he said, and prescribed a number of medications, all of which made her more anxious and sicker. Richard’s takeaway was that the system only motivated care providers to “do” and not to look at the patient holistically with a focus on the quality of care.
Richard said research on care at the time supported his view, indicating that 30 percent of medical services were unnecessary and that evidence-based guidelines for care were followed only 55 percent of the time. Essentially, every service performed was paid for, whether warranted or not, and care was about volume of patients seen, he said.
United Health Care’s model, in contrast, advocates a focus on the patient, rewards preventive care, supports team-based coordinated care, encourages proper follow-up, tracks health improvements and fosters constant data-sharing, according to Richard. This is driving unique partnerships among primary-care doctors, hospitals and insurers, he said.
Now there is a “complete paradigm shift” under way, which is increasing quality of care, better identifying missed care opportunities and reducing severe health events, said Richard. As a result, UHC paid $148 million to Medicare Advantage physicians in 2015 for increased compliance with its guidelines.
Now he said, there is greater community-based care among wellness and fitness centers, clinics, pharmacies, imaging and diagnostic centers and urgent care facilities; proper utilization in the acute-care sector (e.g. hospitals); and greater follow-up care through inpatient rehabilitation, skilled nursing facilities and home care, which is particularly key for aging populations with regard to helping seniors return to independent lifestyles. The patient also plays a more active role, through downloadable information and educational materials, Richard explained.
More broadly, UHC is looking at all aspects that affect health and investing in nutrition programs, housing, transportation, education and behavioral guidance, he said.