The healthcare landscape continues to evolve, and the trend toward value-based care (VBC) isn’t going away anytime soon. While the move away from fee-for-service started years ago, we’ve come a long way from the days where simply getting these models up and running was our biggest challenge. For marketing agencies specializing in healthcare, understanding the shift to accountable and value-based care is essential to helping clients keep pace with this trend and making sure they benefit from the market opportunities that come with it. This positioning is especially important for health technology organizations, as these companies were traditionally selling products like population health stratification tools to health plans, and can now expand their reach to any “risk-bearing entity,” which includes accountable care organizations (ACOs). In this blog, we’ve included the most important information that marketing agencies specializing in healthcare should know about accountable and value-based care. (And if your agency isn’t already up on these trends, you may want to think about looking for a partner skilled in the nuances of accountable care models!)

Marketing agencies specializing in healthcare can not only assist ACOs looking to promote these organizations to providers and patients, but can also help companies looking to market their products and services to ACOs directly.

In order to fully realize the value of opportunities stemming from ACOs and value-based care, it’s first necessary for healthcare organizations and marketing agencies specializing in healthcare to understand what these models are and what they do. Although the terms “accountable care” and “value-based care” are often used interchangeably, “ACO” originally referred to a specific type of model used by Medicare. Formed as part of the Pioneer ACO Program and Medicare Shared Savings Program in 2012, these models were foundational to the current value-based care approaches in the private sector today. This term has now been adopted across payers and health systems as well, and can be used to describe a variety of approaches—from patient-centered medical homes to bundled payment models.

To better understand accountable care, it helps to first recognize the goals for this approach, which are based on the “triple aim” of healthcare reform. This includes improving quality, reducing costs and creating a better patient experience. The trend away from fee-for-service arrangements and toward valued-based care is aimed at motivating providers to consider all three of these areas as they make patient care decisions, in order to reduce overall spending and improve patient health. In fact, value-based care models are driven by collaboration based on financial arrangements between these providers (networks of health systems, independent physician practices, etc.) and a payer. That payer can be Medicare—as it was in the original models—or a private health plan.

It’s also important for healthcare organizations, and their marketing agencies specializing in healthcare, to know the “what’s in it for me.” In other words, how are these models incentivized and how can they benefit both providers and patients?

Incentivizing change in the healthcare system
Value-based care uses a financial contract between the insurer and providers to improve quality of care. Financial arrangements can vary among these models, including incentivized payments (flat bonus fees paid to providers), upside and downside risk (allowing providers to keep a percentage of the cost savings they generate vs. passing on financial risk to them) and capitation. Capitation is the most aggressive type of financial arrangement that involves replacing fee-for-service with a flat fee per member. No matter what financial contract a model uses, keep in mind that it is always tied to improving quality and reducing costs within a population.

Quite often, these populations are Medicare members—but increasingly, they don’t have to be. Even payers serving commercial populations have been dipping their toes in accountable care waters. Many health plans are building specific networks of providers (often referred to as clinically integrated networks) who are willing to take on additional responsibilities to monitor and improve quality in return for financial incentives. Health plans generally encourage adoption of these approaches by promoting both the financial and clinical advantages of these models to employer groups and members.

Every penny counts in improving healthcare costs and quality
Providers in these models are also incented to keep patients healthier with high-quality care, reducing the overall cost burden on the healthcare system. For example, regular touchpoints with primary care providers are linked to the prevention of serious, high-cost health issues for patients down the road via reduced ER visits, improved blood pressure among diabetics and better drug adherence. Lower rates of testing with expensive CT scans and MRIs not only reduces healthcare waste, but also redirects members to less costly methods of diagnosing health conditions.

Along the same lines, a focus on high-quality care has also shaped how value-based arrangements affect change in the system. Knowledge of these key quality drivers will help healthcare organizations and marketing agencies specializing in healthcare understand how valuable, effective care goes hand-in-hand with reducing costs. For instance, promoting lower-cost, high-quality care options like telehealth and ambulatory surgery centers (versus a hospital) has significantly reduced avoidable healthcare spending. All of these strategies serve to identify which populations, services and care incur the most costs in order to find more fiscally responsible, yet clinically effective, treatments.

Stocking up on actionable data
Value-based care and ACO models are fueled by data that speaks to improvement in the healthcare system. This emphasis on information-gathering has prompted adoption of new software and technology including systems focused on interoperability. Interoperability is a means to connect disparate software and data from across the healthcare system including encounter data from EMRs and claims. These systems then normalize the data into standard formats and store it in an easy-to-access location. This is all a lot easier said than done, as interoperability still isn’t the reality in today’s healthcare system. However, CMS and the ONC have been working hard to promote standards for interoperability that will be essential for making this vision a reality.

Some health IT firms look to make this information easier to digest by embedding actionable alerts into their systems to make it easier for providers to actually use this information. There are also health IT providers marketing software that can be used to track quality data—which is essential to understanding provider performance—and even those selling population health stratification and risk management tools. Marketing agencies specializing in healthcare, especially those in health IT, can capitalize on this demand for data by helping their clients market these systems effectively to ACOs.

With the increasing growth and influence of ACOs, it’s clear that this incentivized care model is here to stay. At the end of 2018, there were a total of 1,011 ACOs representing 1,477 distinct, active accountable care payment contracts with public and private payers. Value-based care is starting to make a significant impact on how providers think about quality and costs, and has driven the introduction of many new technologies used to improve care delivery and manage population health.

If you want to know more about this topic, read the latest insights we’ve gained serving stakeholders in the ACO space. Or to find out more about how top marketing agencies specializing in healthcare like Activate Health can help organizations understand the nuances of ACOs and value-based care, contact us today.