Creating a solid end-to-end service — Caremerge's CEO on value-based care

Written by Megan Wood | August 18, 2016 | Print  |

Fee-for-service is on its way out, with the healthcare industry adopting a model of value-based care.

"Patients stand to benefit quite a bit from the shift towards value-based care," says Asif Khan, MBA, founder and CEO of Caremerge, a communication and care coordination platform. "The fee-for-service model has historically not been skewed towards patients' best interests in managing their care."

 

When providing value-based care, healthcare providers must focus on patient outcomes and an excellent end-to-end experience. Collaboration among providers proves crucial in creating a solid continuum of care. Caremerge strives to leverage this care teamwork, facilitating the collaboration of the right stakeholders to enhance a specific patient's care.

 

"We built a collaborative platform that allows the right people to be involved at the right time. So, they can focus on the individual and not the population," says Mr. Khan.

 

Mr. Khan outlines two distinct approaches to value within the new model:

 

The capitation model

  • Encompasses population health
  • Compensates providers on a per life annual basis
  • Involves CMS, a state and a health plan to enter into a three-way contract to provide comprehensive, coordinated care 
  • Focuses on the general population mix

 

Mr. Khan identifies several problems with the capitation model. Since the model includes reimbursement caps, it incentivizes providers to cut costs to more rapidly receive reimbursements.

 

"It's a very high-level program that does bear some short-term benefits, but there are not patient-level outcomes in the capitation model," says Mr. Khan.

 

Bundled payment program

  • Incentivizes collaboration by linking payments for the multiple services beneficiaries receive during an episode of care
  • One central provider guides the patient through the care process
  • Includes risk adjustments
  • Provides an enhanced and simpler patient experience

 

Mr. Khan praises the bundled payment model as it allows providers to focus on their expertise and provide focused quality of coordinated care that may lead to a lower cost for Medicare.

 

"There is one convener that owns that end-to-end service, and that convener partners with other experts in other areas," Mr. Khan says. "You've created a tiny vertical of specialized providers."

 

He sees this model as creating a rich environment of innovation and cost reduction, facilitating competition and entrepreneurship. All of that creates an improved patient experience.

 

"When everyone has the ability to focus on providing the highest quality of care while coordinating with other providers simply and easily – everyone wins, not just the patient," says Mr. Khan.

 

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