Flare Capital Partners’ Ian Chiang describes the key capabilities of a value-based care enablement platform for providers, highlights successful platform examples and offers a framework for entrepreneurs seeking a provider partner.
Ian Chiang is a principal at Flare Capital Partners, a healthcare technology and services-focused VC firm. Prior to joining Flare, he was the SVP of product and innovation and a founding member of CareAllies, Cigna’s family of multi-payer provider services, population health management, value-based care enablement and home-based care businesses. Previously, he was a digital health entrepreneur and a former management consultant at McKinsey & Company.
Value-based care (VBC) enabled by fee-for-value (FFV) payment model has gained significant traction and is increasingly embraced by payers and providers over the past decade (about one-third of healthcare payments in 2017 is tied to value-based care according to US Department of Human and Health Services). However, growth has been slower than many expected. There are many reasons for slower uptake, and one of the reasons is that moving from FFS to FFV is just plain “hard” and “disruptive” for healthcare providers.
Provider organizations have to overcome many cultural, operating model and clinical model challenges when making this transition. To accelerate the adoption of VBC, the industry must make it “easier” and remove potential points of friction. For an industry that is known for complexity, it is imperative for proponents of VBC — be it the government setting policy, a private health plan pushing for FFV contracts, a health system eager to take on FFV contracts or a vendor looking to enable VBC — to follow the “10X” rule. In this case, that means reducing the complexity via technologies and services, and making the transition from FFS to FFV 10 times easier than what it has been.
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In this article, I will:
- Illustrate the complexity of VBC enablement and highlight key capabilities a high-performing healthcare provider organization would need to succeed under VBC;
- Discuss the emergence of VBC enablement platform companies that are aiming to deliver a 10X better experience to help primary care providers transition to VBC; and
- Provide a framework to help entrepreneurs determine if a healthcare provider organization is best suited to partner with “point solution” providers or a “solution platform” provider.
An overview of value-based care enablement and management capabilities
Under VBC, a healthcare provider organization — be it an independent provider group or a large healthcare delivery system — will need to implement new technologies and resources to manage whole-person, evidence-based care, and to take on patient-level financial risks. Many of these technologies and resources were once owned and operated by payers. The task of assembling a wide array of non-clinical VBC enablement and management capabilities is a daunting task for any healthcare provider organizations.
Category 1: Technology infrastructure and population health management technologies (not exhaustive)
- Enterprise data warehouse and data aggregation solutions
- Data integration and exchange (including interoperability) solutions
- Risk stratification algorithm and population health analytics solutions
- Data analytics and reporting/presentation capabilities — both automated and self-service
- Care management and care coordination solutions
- Member/patient engagement solutions
- Business intelligence and analytics capabilities — for operational performance and value-based contract management
- Contract-level analytics capabilities — for total cost of care analytics
Source: Mobi Health News
