The following opinion piece on Value-Based Care appeared on October 2, 2024 in the daily newspapers of Hearst Media Connecticut.
Value-Based Care Helps Connecticut Businesses of All Sizes
By: John Sunde, MHA
To grow the Connecticut economy, we need a healthy workforce.
To properly compete, grow, and thrive, businesses in our state need to know that their employees have access to the right health care at the right time, through plans that are most often provided by the employers themselves. Connecticut employers know the critical nature of having a healthy workforce, understanding that a healthy staff usually equates to a satisfied staff, leading to greater productivity and long-term success for everyone involved.
Across the board, the costs of employee health care plans continue to rise. Recent reports show they are increasing in Connecticut by an average of more than 8 percent and as much as 12 percent in some instances. This is due in part to a proliferation of higher cost specialty drugs and the evolving needs of employees and their families, creating a serious challenge for employers who want to keep their workforce healthy. And this is all set in a world where, over the past generation, we have seen health care driven by the volume of patients seen, rather than by individualized plans focused on quality.
This is where value-based care (VBC) can help, and has helped.
VBC focuses on holistic and preventive care and embracing the whole patient, including all of that individual’s challenges and needs. It is a system where patients visit their physician not only when something is wrong, but for routine check-ups and check-ins, where the physician and patient are never strangers. With VBC, medical visits are not one-off transactions, but a series of encounters that build and strengthen the physician-patient relationship. It is a system where physicians have more time to listen to, talk to, collaborate with and treat patients entrusted to their care.
This is what employers want and patients need to experience success. And we’ve seen it working well firsthand at Southern New England Healthcare Organization (SoNE HEALTH), where putting the emphasis back on the patient and the provider has long been a priority.
Think about it. Lower patient costs for preventive services leads to increased use of personalized care. This results in improved care coordination, which results in fewer emergency department visits, fewer hospital admissions, and, yes, less absenteeism.
In real terms, more people get preventive services such as colonoscopies, mammograms, and flu vaccinations. Risk factors and early disease are more rapidly detected and addressed, which naturally is better for patients and less expensive than late-stage interventions and hospitalizations, as well as missed work time. And chronic diseases, such as high blood pressure, diabetes and kidney disease, are more likely to be kept under control.
Employers have a vested interest in helping to keep their workforce healthy.
Under the sprawling federal Consolidated Appropriation Act (CAA) of 2023, employers saw many more demands placed on them; CAA made employers fiduciaries of the health plans they provide, which means they must act in the best interest of plan participants and will have more say about quality and cost of care. This includes ensuring reasonable costs and transparency in plan selection and management for the health care services provided to their employees.
This means businesses must monitor plan performance in real-time, utilizing tools or experts that can provide insights into spending patterns, plan utilization, and cost drivers, all of which can help in making informed decisions. These requirements align perfectly with provider organizations, such as SoNE HEALTH, that are engaged in VBC.
Such organizations use advanced data analytics and reporting to identify cost effective providers, monitor quality, identify and influence utilization/spending patterns, and assess the value of point solution vendors, such as those providing programs addressing specific chronic conditions. Therefore, establishing an employee benefits plan that maximizes the use of VBC-focused providers helps employers remain compliant with the CAA.
Employers and employees alike desire a health care system with lower out-of-pocket costs and premium costs, better outcomes, and where care is coordinated across providers resulting in fewer unnecessary or duplicative tests and procedures. One with better management — or even the possible avoidance of – chronic conditions such as diabetes and better experiences and outcomes overall, thanks to stronger patient engagement with a primary care physician and a team of providers who work collaboratively in their healthcare journey.
A healthy and productive workforce means sustainability and growth for businesses of all sizes, paving the way for future success. Through value-based care, companies become economic engines for the prosperity of the state, as well as guardians and stewards for their workforce by doing everything possible to help their employees achieve healthier, happier, and productive lives. That is something we can all get behind.’
