The health care industry has undergone several significant changes over the past few years. Telemedicine, automation, and an emphasis on cybersecurity are among the most prominent, but value-based care technology is rising, too. Medical organizations and insurers should pay close attention to this trend as it grows.
What Is Value-Based Care?
Value-based care (VBC) is a model where providers base their billing on patient outcomes rather than the quantity of care. The Centers for Medicare and Medicaid Services (CMS) first started implementing VBC programs in 2012, citing their ability to lower costs and improve care for communities and individuals.
VBC proponents point to how the conventional fee-for-service (FFS) model may incentivize unnecessary procedures because it rewards providers for the amount of care they provide, not how effective it is. A value-based model, in contrast, pays providers for quantifiable evidence of patient health improvement, encouraging a higher quality of care.
This model’s growing popularity coincides with telehealth and similar technology trends because VBC needs data-centric technologies to work. Setting and analyzing value-based care metrics requires a system to determine and gather relevant data. Consequently, as health wearables and similar data-gathering devices have become more accessible, the VBC model has become increasingly viable.
Impact of VBC on Medication-Assisted Treatment
As value-based care technology has improved, more providers and insurers have adopted this model. Now, experts say there could be a significant surge in value-based models over the next few years. Here’s how that trend may impact medication-assisted treatment policies and procedures.
Increased Data Requirements
One of the most significant impacts of VBC is the need for more data. FFS models are far easier to manage in terms of billing information because all it takes is a record of what services a provider offered. Value-based care metrics are more complicated, requiring a wider range of data to measure and provide to patients and insurance companies.
Health care providers will need to determine specific metrics for measuring patient health outcomes. Possible factors include days between treatment and future appointments, changes in self-reported wellness scores, or prominence of symptoms. These metrics will likely vary between cases and patients, too, so providers need tools that can track multiple data points.
These rising data needs have two major budgeting implications. First, hospitals and other practices must adopt appropriate internet of things (IoT) devices to track these many metrics. Second, they’ll need to bolster their IT infrastructure to manage larger data volumes safely and efficiently.
Rising AI Adoption
As value-based care technology increases health care data volumes, it could push providers to broader artificial intelligence (AI) usage. Despite its many relevant benefits, AI adoption has lagged in health care. Just 0.05% of job postings in the sector require AI-related skills, placing it lower than every industry but construction. VBC could change that.
Collecting data on relevant metrics is only the first step in using them to shape billing practices. Providers must also analyze this information to determine how these trends reflect the efficacy of various medications. AI tends to perform this kind of analysis faster and more accurately than humans, making it an essential part of employing these models.
It’s important to recognize that AI comes with plenty of privacy and ethical concerns, especially in the health care sector. Consequently, medication-assisted treatment policies and procedures must include specific protocols for ensuring they use this technology fairly and keep humans as the final decision-makers.
Higher Cybersecurity Concerns
Rising data rates and AI usage will drive another growing health care trend further: Cybersecurity. There were more than 590 health care data breaches in 2022, impacting more than 46.8 million people’s information. As value-based care companies grow and collect more patient data, those breaches could become even more damaging.
The medical industry already faces stringent privacy standards, but its recent record of data breaches indicates a need for higher security. If providers want to fully capitalize on value-based care, they must ensure they increase their cybersecurity measures as quickly as they embrace digital transformation.
Zero-trust architecture, automated network monitoring, multi-factor authentication (MFA), and IoT security may be necessary. Providers that don’t adopt these practices as they gather more patient data may quickly find themselves in legal trouble.
More Emphasis on Patient Engagement
Finally, medication-assisted treatment programs will have to invest more in encouraging patient engagement. Value-based care metrics often require action on the patient’s side, either from self-reporting or visiting a professional. Failure to do so doesn’t heavily impact billing in an FFS model, but it could dramatically alter a VBC program, as it limits the available data on a medication’s efficacy.
Providers can mitigate this issue by using telehealth devices that automatically capture and send data. Still, that approach only works for some metrics and conditions, so hospitals and pharmacies must also encourage patients to become more engaged in their own care.
Gamification, rewards, and informational programs that highlight the benefits of engagement can help. However, it may be more effective to make engagement as easy as possible. If the industry can adapt to become less complicated or inconvenient on the patient side, patients will be more inclined to actively participate in their own care.
Value-Based Care Creates New Challenges and Opportunities
Value-based care technology could drive many improvements in medication-assisted treatment policies and procedures, including lower treatment costs and better patient outcomes. It will also introduce some challenges, like a growing need for reliable cybersecurity and pressure to digitize rapidly.
Providers must understand and prepare for these challenges and opportunities now to make the most of them in the future – as value-based care’s popularity grows, their success in the industry may depend on it.
By Shannon Flynn, ReHack