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Analyzes motivated by artificial intelligence could transform value -based care by attacking longtime ineffectiveness and allowing suppliers to provide better results at lower costs.
It is among the main conclusions of a Report of health adviserswhich also highlighted the persistent challenges faced by value -based care.
Despite significant investments, value -based care (VBC) has struggled to obtain its initial promise to improve the quality of care and reduce expenses.
The point of view of the industry is that the payment of certain suppliers prospectively according to the results – rather than retrospectively according to each service provided – tends to better support the health of patients and to reduce the overall excess expenditure for insurers.
Why this counts
The report notes one of the biggest problems with VBC is its dependence on complex financial models instead of the direct activation of suppliers.
Over time, the plans have introduced complex refund Structures with numerous allocation, use and quality measures, executives who force suppliers to navigate in contradictory measures and to analyze large amounts of complaint data.
It is a process that often overwhelms suppliers, which makes them difficult to focus on improving care.
“Providers are stuck in the navigation of endless data while being held responsible for the results that they could not influence,” said the report.
Fragmentation in health plans adds another layer of complexity. The management of the VBC program is often distributed between quality, network and products teams, leading to disjointed efforts and ineffectiveness.
The AI presents the opportunity to meet these challenges and bring VBC closer to its planned objectives.
Switch to a model focused on results
The implementation of various AI tools, supported by the strategic management of programs could transform VBC of a fragmented system and underperforming into a rationalized model and focused on the results, according to the report.
Predictive analytical Propelled by AI could help suppliers pass reactive to proactive care population health management. By analyzing the models in patient data, AI can anticipate future health problems, allowing early intervention for chronic diseases.
The additional advantages provided by AI tools may include assistance for assistance providers to identify patients at high risk earlier in their progression of the disease – going for targeted awareness and preventive care – or for Allowing early intervention, helping providers to manage chronic diseases more effectively.
This change not only improves patient results, but also reduces the costs associated with complex treatments and hospitalizations.
The role of health plans
To maximize the potential of VBC, health plans must also adopt a disciplined approach to programs management, with the definition of clear objectives and on the essential organization to align resources and ensure support of the parties taking.
Treatment of VBC as a range of distinct products with its own profit and loss measures can help health plans to assess economic benefits and prioritize high impact models.
“A unified” northern star “is essential for the alignment of stakeholders and the optimization of resources,” said the report.
This approach would allow plans to assess both individual models and their global portfolio to identify ineffectiveness and evolve successful initiatives.
“In the end, by improving the authorization of VBC suppliers with predictive tools and an AI, the plans will ensure that suppliers have the tools they need to succeed, by concentrating critical resources on the right patients, improving The results and by gaining more value -based incentives, “concluded the conclusive report.
The biggest trend
The centers for Medicare and Medicaid Services said that value -based care models experienced a 25% increase in service providers from 2023 to 2024 Medical economy. This includes participation in value -based care models such as managed care organizations, Responsible care Organizations and Medicare advantage.
The report indicates that the global value -based health care market, worth $ 12.2 billion in 2023, is expected to reach $ 43.4 billion by 2031. It also said that a MCKINSEY report has shown that companies engaged in value -based care created around $ 500 billion in corporate value in 2022, a number that could reach 1 dollars by 2027.