Fragmented care. Variable quality. Declining patient engagement. These are just a few urgent challenges the U.S. healthcare system faces today. How did we get here? 

There isn’t one answer. But one key contributor to many of these issues has been fee-for-service care — a traditional payment model centered on billing per visit, test, or procedure. Critics often argue that, by its nature, the fee-for-service status quo incentivizes unnecessary care, might discourage effective care coordination, and largely falls short of providing patients with the best-in-class experiences they deserve. 

That’s why more and more providers, and even healthcare startups, are taking risk on value-based care models — payment systems based on the quality of care (as opposed to the volume of care) provided. However, this change often presents a whole new host of obstacles to overcome. Let’s dive into some of the hurdles organizations face when implementing value-based care and how intelligent care enablement can help address them.

What are some challenges to implementing value-based care?

Implementing value-based care is a complex endeavor for healthcare organizations, as it requires a fundamental shift in their approach to care delivery. And although this payment model is set to grow exceptionally over the next decade, several systems face challenges during change that can impact the ability to provide high-quality care while controlling costs. Some common barriers providers often encounter include:

• Lack of data integration and interoperability: One significant challenge is integrating and sharing patient data across various healthcare settings and fragmented point solutions. Disparate electronic health record (EHR) systems, limited interoperability, and data silos hinder the seamless flow of information. Three out of four healthcare leaders say data interoperability is the top priority for their organizations. But with 70% of providers still relying on faxing for sharing patient information, the industry has a long way to go.

• Outdated risk stratification and care management processes: Identifying patients who would benefit from value-based care programs is essential for ensuring their effectiveness. However, this process is often done manually through telephone outreach by nurses or other staff — presenting inherent inefficiencies that slow down operations and add more burden to the workforce. 

• Poor care coordination and communication: Subpar care coordination and limited patient communication can lead to unnecessary care — such as duplicate testing — or preventable readmissions. One in five aging patients experience an adverse event when transitioning from hospital to home — scenarios that could lead to rehospitalization. In a value-based care model, effective collaboration among multiple providers is critical for preventing unintentional harm.

• Inconsistent patient engagement and education: Encouraging patient engagement and education is a critical component of value-based care. However, motivating patients to actively participate in their care and adhere to medical guidelines can be a substantial challenge. Healthcare organizations must invest in patient education resources and develop strategies to teach patients to self-manage their conditions — not just in the short-term, but over time in cases of chronic or complex care journeys.

• Outdated technology and limited IT support: The adoption of digital healthcare solutions, data analytics tools, and telehealth platforms comes at a cost. Healthcare organizations must invest in the necessary technology and infrastructure to support value-based care. But with around 70% of hospital-led IT projects facing significant hurdles or failing altogether, it’s clear most systems still need to refine their technology development and implementation processes — or partner with an experienced digital healthcare vendor to spearhead their initiatives.

How can intelligent care enablement support value-based care?

Transitioning to a value-based care model isn’t simple, and the aforementioned challenges aren’t going to be solved with one panacea. However, intelligent care enablement — scalable technology that supports both patients and care teams through complex clinical episodes to more efficiently deliver personalized, proactive, and coordinated care — has the potential to support a more seamless implementation by:

1. Helping reduce unnecessary care and readmissions 

The unfortunate symptom of poor care coordination and communication is an uptick in readmissions. One study found patients with a clear understanding of their care protocols at the point of discharge were less likely to be readmitted. But after discharge, how can providers help patients once they exit the hospital and return home?

Forward-thinking technology supported by conversational AI in healthcare — such as Memora Health’s intelligent care enablement platform — empowers providers upstream from care episodes by independently educating patients on conditions and providing an always-on assistant that’s there for them when they need it.  

No matter the service line — oncology, renal, cardiology —patients are equipped with clinically relevant insights available at their fingertips and providers can rely on responsible automation for routine follow-up. This could help reduce unnecessary trips to the hospital, motivate patients to learn more about self-managing their care, and enable clinicians to better understand their patients’ needs before more acute scenarios emerge.‍

2. Reinforcing care plan adherence

Treatment adherence is one of the main determinants of positive health outcomes for healthcare’s most at-risk patients. But research tells us that many people don’t take their prescriptions as directed. In fact, one figure found over half of asthma patients fall off track.

Value-based care programs graded by care quality need to crack the code to get their patients to comply. And innovation could be the way forward.

By automating routine check-ins related to medication schedules and care guidelines, intelligent care enablement technology helps people stick to their treatment plans. Memora’s platform uses conversational AI to take things a step further, enabling patients to ask care journey-related questions and surfacing actionable resources to assist them. 

Find out how Memora Health helped one large health system's oncology department improve its patients' medication adherence.

3. Supporting equitable care

Patient populations aren’t healthy until everyone’s healthy. And delivering equitable care is particularly central to implementing effective and sustainable value-based care programs. Investing in health equity is a key pillar of CMS’s standards, with subsequent penalties on the table for organizations that don’t meet them — even when disparities might be out of hospitals’ control. 

That’s why value-based care organizations need innovative technologies that extend care support beyond the immediate bedside interaction to truly support its most at-risk patients. The first step is knowing what barriers your surrounding communities face, and intelligent care enablement helps providers do that by proactively collecting SDOH data and patient-reported outcomes (PROs), then organizing it in an accessible way for care teams.

But Memora Health’s platform intrinsically understands that knowledge isn’t enough. Our technology helps to identify disparities — such as lack of transportation — and provides patients with useful resources to help overcome them.

4. Reinforcing remote patient monitoring

Remote patient monitoring (RPM) tools such as wearable devices, mobile apps, and heart monitors allow patients to track their health conditions from home or alternative care settings. But much of the resulting data largely lives in disparate systems, making it difficult for providers to access and use it. 

With interoperability key to better care coordination — and, thus, improved quality outcomes — value-based care arrangements need a better way to organize and share their RPM data. 

Intelligent care enablement technologies are designed to address this issue. They don’t just funnel RPM information into the ether. They convert these insights into highly actionable views of patient status, empowering providers to more efficiently glean the data they need and act on it. This proactive approach not only improves patient outcomes, but also lowers overall healthcare costs through more efficient care delivery at home.

5. Assisting with complex care journeys

Some acute episodes of care — such as infections — are completely treatable in the short-term. However, chronic conditions require ongoing management to minimize symptoms and help patients avoid complications. They require continued care and meticulous treatment regimens. 

Value-based care programs prioritize patients facing chronic or complex conditions, as they require significant care management assistance, and thus healthcare spending. But analog solutions hospitals continue to leverage are minimally effective, adding more costs to already strained systems and more stress to overburdened workforces.

That’s why Memora Health designed its intelligent care enablement platform to specifically address this issue. Using conversational AI that draws on clinically relevant and care team-approved content, our technology responsibly answers to care-related questions from patients with chronic conditions, responds to requests for medication refills, and triages potentially concerning messages to their care team member — all without human intervention.

The transition to value-based care is driven by the desire to deliver higher-quality care, control costs, engage patients, align with healthcare reform goals, facilitate financial sustainability, leverage data for decision-making, and maintain a competitive edge in an evolving healthcare landscape. Intelligent care enablement will be essential as health systems and health technology innovators strive to meet these objectives.

Want to see what Memora Health can do for your value-based care initiatives? Speak with one of our experts today.