Introduction to value-based care
Value-based care (VBC) is one of the most important tenants in healthcare transformation today. Achieving high value for patients is the overarching goal of healthcare delivery in VBC, with value described as the health outcomes achieved per dollar spent.
Transition to VBC has its challenges. Accountable Care Organizations (ACOs) were the first big innovation in value-based health and are key to the VBC payment movement. However, a value-based approach in all healthcare organizations and platforms, including digital health, is critical to redesigning and integrating healthcare delivery that prioritizes individual patients’ needs.
According to Barry Arbuckle, President, and CEO of MemorialCare Health System,
Delegated or assigned networks with strong, well-defined value-based alignment — including clinical quality, patient experience, contained cost — will prove to be superior to the consumer and the U.S. healthcare system.
As value-based care reimbursement becomes a reality for providers, many will begin adopting useful digital health platforms and tools that improve their population health management efforts. Digital can meet the needs of reimagined delivery models.
Triple aim: relevance to ACOs and VBC initiatives
The triple aim, created by the Institute of Healthcare Improvement (IHI) in 2008, was enacted as a means to improve the U.S. healthcare system through three specific pathways:
- Improving the experience of care
- Improving the health of populations
- Reducing per capita costs of healthcare
Unlike the quadruple aim, which includes healthcare practitioners, the triple aim focuses on patients.
According to researchers at the IHI, three main principles guide organizations using the Triple Aim as a tool:
- Creating the right foundation for population management
- Managing services at scale for the population
- Establishing a learning system to drive and sustain the work overtime
Instead of utilizing a top-down approach to achieve the Triple Aim, organizations should look for ways to involve staff members in the process to better understand how to reach these goals.
Digital behavioral health models can enhance the principles of the Triple Aim (enhance the patient experience, improve health outcomes, and lower cost of care) and, hence, provide value to VBC.
Digital health and its potential value to VBC
On January 26, 2015, the Department of Health and Human Services (HHS), for the first time, announced specific, measurable goals and a timeline to move Medicare and the healthcare system away from payment based on the quantity of care towards a phased adoption of alternative payment models based on quality.
Since then, the digital health market has grown from an early, fledgling segment into a force of change. According to Rock Health, $4.2B was invested in digital health through the first half of 2019.
Digital health has potential value to VBC as it has several applications:
- Virtual clinical trials – There is an increased interest in virtual clinical trials in which participants don’t have to leave the comfort of their homes. Digital platforms can collect patient information and, in some cases, detect data from wearable devices.
- Artificial Intelligence (AI) applications – the job of AI is to refine raw data into a usable format. Digital companies can leverage AI applications to bring value to patients.
What are some current value-based care initiatives?
Below, we discuss some current VBC initiatives offered by digital health.
1. Internet-delivered digital interventions for mental health management
Internet-delivered treatments have been referred to as online interventions, web-based interventions, e-therapy, e-health, and internet-delivered cognitive behavior therapy (iCBT).
Within mental health services, iCBT interventions have become a method for the dissemination of established evidence-based treatments for a broad range of mental health difficulties, including depression and anxiety disorders and health issues such as smoking cessation and stress management. More recently, they have begun to address the behavioral health aspects of long-term conditions such as diabetes, coronary heart disease, and chronic pain.
2. Digital health platforms reduce healthcare costs
Although technological advances are often seen as the most important driver of increased healthcare costs, digital health can do the opposite. Digital health platforms typically feature innovative software solutions, and these solutions could be less costly than devices or drugs.
Early cost-effectiveness studies suggest that there could be large public health savings with the use of internet-delivered interventions for treating depression and anxiety in mental health services.
A recent systematic review of economic evaluations of internet-delivered interventions for mental health highlighted that interventions for depression and anxiety demonstrated cost-effectiveness compared to unguided interventions, waiting list controls, treatment, as usual, group CBT, and telephone counseling.
3. Digital health platforms enhance efficiency and productivity of providers
Physicians often miss opportunities to educate their patients or perform some action steps during patient visits. These missed opportunities stem from a general lack of efficiency in health systems. According to Deloitte insights, the number one expectation of physicians is that digital health would improve their efficiency by saving time and resources. Digital tools have the potential to increase diagnostic efficiency and automation, which means that physicians can free up some time to increase the quality of care to their patients.
4. Digital health improves access to healthcare
Low-income communities typically have limited access to high-quality healthcare. However, with the constantly increasing convenience of digital health platforms, both high-income and low-income patients will have improved access to a wide range of health services.
Digital behavioral health platforms can be delivered via web browsers or apps, which means that patients do not have to travel to a site to get the same level of care. Digital mental health provides on-demand access anytime, anywhere, and when people need it.
Implementing digital mental health services in value-based care solutions
Digital healthcare models can address the mental health pandemic in the U.S. From a policy perspective, among the goals of Medicaid redesign efforts in recent years (also known as the Delivery System Reform Incentive Payment Program or DSRIP) is to transform the delivery of mental and behavioral health services for those with mental and behavioral health needs and to prepare providers to move toward value-based reimbursement.
Also, states are eager to support the evolution of single-focus providers (medical, behavioral, and social services) into high-performance integrated systems that can support individuals with mental health and substance use disorders.
Another way to implement digital mental health services in VBC is to tie payments to improved mental health. When ACOs do a good job addressing mental health in their population, they should receive larger payments. Connecting payments to improved mental health can elevate best practices, finance further improvements, and get more systems to invest in mental health treatment.
Evidence supporting the delivery of digital mental health interventions
Several meta-analytic studies have now demonstrated the efficacy of iCBT for depression. The earliest of these studies included computerized and internet-delivered interventions. and consistently reported the same results: that iCBT is effective as an intervention for the treatment of depression.
The ability of internet interventions to maintain clinical gains at follow-up can contribute significantly towards their acceptability, adoption, and implementation in clinical practice. Several trials incorporated follow-up to 6-months or 12-months post-treatment (Andersson et al., 2005; Berger et. al, 2011; Montero-Marin et. al., 2016), demonstrating that iCBT has the potential to achieve and maintain significant clinical gains for users. Achieving outcomes that are similar to what has been achieved in face-to-face treatments for depression only strengthens the validity of iCBT interventions for depression.
How Amwell can improve mental health using evidence-based tools
Digital mental health platforms, such as SilverCloud® by Amwell®, comprise a suite of evidence-based tools that encourage people to improve their mental health and empower them with self-managed mental and behavioral health programs tailored to an individual's specific care needs.
Up to 65%+ of SilverCloud® users show a clinically significant reduction in symptom scores. *A reduction on PHQ-9 depression score of 3+, or a reduction on GAD-7 anxiety score of 2+.
These insights contribute to the growing research base that is supporting digital mental health interventions like SilverCloud. Health systems, ACOs, IPAS & primary care groups, and federally qualified health centers (FQHCs) should choose digital mental health platforms like SilverCloud to improve mental health outcomes and achieve VBC goals.