5 Reasons to Implement a Virtual Integrated Delivery Network for High-Cost Populations
VIZI Health Solutions
09/29/2017
As health plans and their provider networks continue to shift to value-based contracting, caring for chronically ill seniors and other high-cost populations gains increased importance. Since these populations frequent the hospital-centric care system on an episodic basis consuming 80 to 90 percent of a health plan’s medical budget, clinically insulating them in a lower cost community-based care system will not only reduce the overall cost of care, but it will enable these populations to thrive in their home environments.
Background
To help clinically integrate payer populations across regions and increase leverage over health plans, large health systems have acquired and built a multitude of hospitals, clinics, and other ancillary services to create Integrated Delivery Networks (IDNs). However, these IDNs are still hospital-centric, focused on the acute episode, and are plagued by all the same problems they have tried to fix like unnecessary re-hospitalizations, medication errors, and network leakage to name a few. As a result, healthcare expenditures have increased while health plans have struggled to control medical costs. Value-based contracting between health plans and physician groups is a good first step to share risk, but finding those medical groups, and keeping them happy in a mutually beneficial relationship is not easy. Additionally, exiting tools for case management outreach and population analytics have shown their limitations in proactively engaging members and keeping them out of the hospital.The Next Generation Health System is Not Hospital-Centric
For those looking to clinically integrate high-cost populations in community-centric care settings, and avoiding unnecessary hospitalizations, creating a virtual integrated delivery network is the perfect next step.As you put your 2018 strategic plans in place, I briefly describe five major benefits to effectively managing high-cost populations in your own virtual integrated delivery network. Additionally, if you would like assistance from our team of clinicians, information technology experts, and process engineers, please fill out the form below for a complimentary assessment.
1. Improving the Patient/Member Experience
What health plan doesn’t want to increase enrollment, win statewide contracts, and close that big employer? Your virtual integrated delivery network will allow you not to just lower medical expenditures, but more importantly, it will allow you to deliver a better member experience by effectively coordinating care in the home. When acute exacerbations happen, your care management team will be more empowered to get your members to ancillary providers that are best equipped to care for them. A common frustration among members who have complex conditions is the lack of continuity with each of the different care teams that assist them. “No one talks to each other”, and “I have to repeat myself over and over” are common complaints when members are sick. What are worse are the gaps in care as a result of this miscommunication. Turn a lack of care continuity into an improved member experience by implementing a virtual integrated delivery network. Your work will not only show up on the medical expense line, but it will also show up on member satisfaction scores enabling you to win more business and feed your marketing machine.
2. Improve Clinical Control Though Transitions of Care
Unnecessary re-hospitalizations are a big problem for medically complex populations. According to the Agency for Healthcare Research Quality (AHRQ), Medicare, Medicaid, and privately insured populations, 3.1 million patients are readmitted costing over $40 billion annually. Since virtual integrated delivery networks create a “closed-loop” care system, identifying a member when they are admitted into the hospital, and matching the member’s level of care requirements to a curated ancillary provider that can meet those specific needs, you will see unnecessary re-hospitalizations drop significantly. In one virtual integrated delivery network deployment we saw a readmissions reduction of over 70% for high-risk elderly populations.
3. Improve the Physician Experience
How are your health plan’s physician relationships? Are you looking to recruit more primary care physicians? Are you looking to build mutually beneficial value-based partnerships with your network? Primary care is at the heart of advanced alternative payment models. The problem is that practices can get financially “upside down” with chronically ill seniors, and lack the tools to proactively address their care during an 8-minute office visit 3 times per year. Let your virtual integrated delivery network be the solution to recruit, retain and reward your primary care network. By virtually connecting your primary care physicians into the home through a community based multi-disciplinary team and building member-centric care plans with smart alerts, your physicians will have more clinical control to keep members in their homes, and improve their financial performance.
4. Improve Financial Performance in Fee For Service and Value-Based Contracting
We are straddling a fence between two payment models, but we all know the shift is well underway to advanced alternative payment models. We also know that the shift in payment models is not a light switch, but a journey to get your proprietary systems in place, figure out what works and building the right muscle memory to succeed in the new world. A virtual integrated delivery network is the perfect organizational initiative to deliver results today while creating the next generation system of care for tomorrow. For example, a virtual integrated delivery network can be bi-directional from the hospital and from the medical home. This allows you to focus on not only reducing hospitalizations but also on reducing patient leakage for your aligned primary care practices.
5. Improve Patient/Member Safety and Quality Assurance
Your virtual integrated delivery network is built to not only curate and connect disparate care teams for better coordination, but it also match member needs to the best network providers that can address those needs. By cataloguing network provider capabilities across key areas, members are referred to providers best equipped to service them. A couple of examples are matching clinical & therapeutic staffing capabilities to member needs and pushing electronic medication lists between care teams to reduce transcription errors. As you standardize your clinical and non-clinical pathways with your network providers and automate member transitions into those pathways, you will see a dramatic reduction in errors and an increase in overall quality.
The above is a brief summary of the benefits health plans can leverage by creating their own virtual integrated delivery network. The biggest benefit, however, is its low cost since the plans use existing assets already in place. If you would like our team to provide a complementary assessment of building a virtual integrated delivery network in your market, please fill out the below form.