Harvard Study Finds Value-Based Care Has a Third Critical Dimension

October 01, 2019

Value-based care is a proven strategy for improving quality of care at lower cost – and is an approach UnitedHealth Group has supported for years. Now, two Harvard researchers have identified a third dimension to achieving value-based care – what they call “infrastructure support.”

Why Infrastructure Support Matters

For years, leading providers and payers relied on quality and spending-reduction incentives to lower costs and improve care. This strategy, value-based care (VBC), shifts the focus from the number of tests or procedures performed to actual outcomes.

Dr. Alyna Chien of Harvard Medical School and Professor Meredith Rosenthal of the Harvard School of Public Health wanted to better understand how VBC works and they reviewed 10 years’ worth of VBC programs. Their report, “A 3D Model for Value-based Care,” identified infrastructure support as the missing third dimension that accompanies quality and spending-reduction incentives.

The Six Types of Infrastructure Support

Chien and Rosenthal identified six types of infrastructure support and how often VBC programs use them:

  1. Analyze data or reports on spending, quality and key measures (92% of programs).
  2. Provide technical assistance to help build new capacities such as training, knowledge sharing and learning collaboratives (83%).
  3. Produce raw, unanalyzed administrative and claims-based data (63%).
  4. Make infrastructure payments in the form of in-kind financial supports not linked to performance (50%).
  5. Conduct risk management support to protect participants from large losses (33%).
  6. Offer access to care management support such as personnel or tools to assist with patient care and coordination (29%).

In interviews with 24 leading VBC providers for the study, five themes emerged for the next generation of VBC:

  1. Value-based programs require substantial organizational change.
  2. Shared data is the foundation of successful VBC relationships.
  3. Increased capacity in care management strengthens their practice.
  4. Re-setting payer provider relationships unlocks innovative program design.
  5. Leadership commitment and stamina are critical success factors.

Five Ways to Adopt Value-Based Care

Based on their research, Chien and Rosenthal make five recommendations to help care providers and payers accelerate the impact and adoption of value-based programs:

  1. Use the 3D model to design VBC programs – do not rely on financial incentives alone.
  2. Build stronger payer-provider relationships based on organizational alignment and data sharing.
  3. Align how VBC is measured across different payers – there is too much inconsistency today.
  4. Increase the share of provider reimbursements tied to value-based payments to create more shared risk.
  5. Better align individual physician incentives with the value-based contract incentives negotiated by their leadership.

“The findings of this research affirm our sense that, as an industry, we make the greatest progress when we work in true partnership with care providers and always keep the patient experience at the center of everything we do,” said Dr. Lewis Sandy, EVP, Clinical Advancement, UnitedHealth Group. “Harvard’s recommendations set out a shared agenda for the future of VBC program design that will inform and shape our own efforts.”

Read the study