The health care industry is swiftly moving toward value-based care with providers taking on more risk for their performance and the health outcomes of the populations they manage. Today, nearly every health system is operating under some form of value-based care – whether through the Centers for Medicare and Medicaid Services (CMS), commercial payers or their own employees.
Factors contributing to the drive for value-based care
Value-based care is gaining momentum in significant ways. By 2018, the Department of Health and Human Services aims to tie 90 percent of all Medicare fee-for-service (FFS) payments to a value metric and 50 percent to alternate payment models.
Health systems are looking to new reimbursement models that emphasize improved clinical and financial outcomes, including the creation of provider-sponsored health plans (PSHP) and Medicare Advantage (MA) plans. More and more health care leaders recognize the need for actionable data and insights that can be integrated seamlessly into the workflow, empowering providers to more effectively assess risk and apply appropriate interventions at the point of care to maximize patient outcomes.
Value-based care strategies for health systems
For many health systems, this moment is critical: Realizing there is a substantial need to change and adopt strategies to move toward value-based care.
At Lumeris, we’ve seen this marketplace change coming for a long time. That’s why we’ve entered a 10-year, strategic operating relationship with Cerner (pending regulatory approval), that will create a new collaboration that leverages the significant investments health systems have made in digitizing their clinical and process data. The closing of the transaction is pending the expiration or termination of all applicable waiting periods (and extensions thereof) under the Hart-Scott Rodino Antitrust Improvements Act of 1976.
Known as Maestro Advantage™, this collaboration is expected to help health systems manage the complexity and friction they encounter as they adopt value-based care strategies.
Maestro Advantage™ will combine clinical and operational workflow technology that can work with any EHR platform coupled with a proven Accountable Primary Care delivery model tailored to meet the needs of health systems that are standing up PSHPs and MA plans. Managing an organization-wide shift away from FFS is a tall order, particularly as leaders look to align their organization and network of providers around a shared business model. Maestro Advantage™ will be designed to help providers accelerate the transition to value-based care through PSHPs and MA plans, particularly in health systems that have multi-vendor technology portfolios by:
a) Positioning them to benefit economically by capturing “first-dollar revenue” through more efficient management of populations;
b) Accelerating the relationships they have with payers, providers and affiliated services organizations to reduce friction and enhance the member experience; and
c) Empowering a “re-imagined” provider-patient relationship with all the necessary services and capabilities to deliver high-quality, affordable, integrated care by enabling primary care to be delivered systematically throughout the health system and out into the community it serves.
Breaking down the barriers to value-based care
Overall, U.S. health care systems have been slow to transition to value-based care. The health care industry lacks the infrastructure necessary for organizations to move to payment models that place a significant portion of their revenue streams in value-based arrangements. Maestro Advantage™ is expected to disrupt that notion by delivering the infrastructure, technology and expertise, helping organizations drive higher-quality outcomes, lower costs and improved patient and provider satisfaction measures.
We’re focused on connecting traditional venues, the health continuum and advanced information about a person’s lifestyle to empower individuals in their health and care. Learn more here.
All statements in this blog post that do not directly and exclusively relate to historical facts constitute forward-looking statements. These forward-looking statements are based on current beliefs, expectations and assumptions with respect to future events and are subject to a number of significant risks and uncertainties. It is important to note that Cerner's performance, and actual results, financial condition or business could differ materially from those expressed in such forward-looking statements. The words “positioned”, “expect”, “will”, “designed” or the negative of these words, variations thereof or similar expressions are intended to identify such forward-looking statements. Factors that could cause or contribute to such differences include, but are not limited to: the possibility of significant costs and reputational harm related to product-related liabilities; potential claims for system errors and warranties; the possibility of interruption at our data centers or client support facilities that could expose us to significant costs and reputational harm; the possibility of increased expenses, exposure to legal claims and regulatory actions and reputational harm associated with a cyberattack or other breach in our IT security; our proprietary technology may be subject to claims for infringement or misappropriation of intellectual property rights of others, or may be infringed or misappropriated by others; material adverse resolution of legal proceedings; risks associated with the unexpected loss or recruitment and retention of key personnel or the failure to successfully develop and execute succession planning to assure transitions of key associates and their knowledge, relationships and expertise; risks related to our dependence on strategic relationships and third party suppliers; significant competition and our ability to quickly respond to market changes and changing technologies and to bring competitive new solutions, devices, features and services to market in a timely fashion; managing growth in the new markets in which we offer solutions, health care devices or services; long sales cycles for our solutions and services; risks inherent in contracting with government clients, including without limitation, complying with strict compliance and disclosure obligations, navigating complex procurement rules and processes and defending against bid protests; changing political, economic, regulatory and judicial influences, which could impact the purchasing practices and operations of our clients and increase costs to deliver compliant solutions and services; non-compliance with laws, government regulation or certain industry initiatives; and, failure of the parties to achieve the intended benefits of the collaboration. Additional discussion of these and other risks, uncertainties and factors affecting Cerner's business is contained in Cerner's filings with the Securities and Exchange Commission. The reader should not place undue reliance on forward-looking statements, since the statements speak only as of the date that they are made. Except as required by law, Cerner undertakes no obligation to update forward-looking statements to reflect changed assumptions, the occurrence of unanticipated events, or changes in our business, results of operations or financial condition over time.