Healthcare is rapidly moving to value-based care (VBC)—a move that requires both clinical and financial transformation to be successful. This transformation holds great promise for healthcare, but I’d like to argue that what has most prevented VBC from living up to its potential is the lack of digital collaboration tools found elsewhere in true (and profitable!) transformations.
Let me explain.
For many payors and providers, the transition to VBC hasn’t been easy. A recent survey by
the Institute for Medicaid Innovation revealed that despite the promise of VBC to transform care and cost outcomes, most health plan leaders view provider reluctance to adopt incentive-based models as an external barrier (see findings at right).
It’s easy to chalk this up to a lack of willingness or data sharing, but what if we dug a little deeper? Buried beneath these statistics is the root cause: payors and providers are reluctant to adopt incentive models because they have experienced mixed results.
There hasn’t been a clear answer on what models work best. Add to that the investment needed to operationalize VBC and the fact that negotiating these arrangements can be time consuming and complex, it’s no surprise that many providers are left questioning:
Is the juice worth the squeeze?
There are many VBC solution vendors working to fix this problem, but most have ignored a critical root cause: technology enabled and collaborative incentive program design. Instead, it seems the strategy has been “let’s create population health dashboards and gaps in care lists and if we do enough, we’ll surely generate outcomes and achieve results”. Sound familiar?
Hope is not a strategy and value-based models are not one-size-fits-all. The tactics and interventions that work for one population and provider cohort won’t necessarily work for another. This is why my former health plan colleagues are struggling to engage providers in risk sharing programs at scale. You can’t fix poor design downstream, and no amount of care intervention will solve for a payment structure that is flawed from the start.
At Syntax, we know there is a better way to dramatically increase the odds of success: a two-sided analytics platform that digitizes value-based care contract modeling and provides a workspace for direct collaboration—enabling end to end VBC negotiations and management.
It may sound too good to be true, but it isn’t. This platform approach has driven success and profits in technology for years—just not in healthcare. In Forbes, Seth Joseph recently discussed the dampened profits of digital health companies relative to their tech peers and made the argument:
Platform businesses create value by bringing different constituents together and facilitating an exchange of value between them, not by selling software to either side. Think of Airbnb or the Android mobile operating system. It is a different approach altogether, and generally leverages network effects to drive growth, defensibility, and profitability. It also works, as suggested by research showing that platforms grow faster, are more scalable, and more profitable than their software-only counterparts.
“The largest next-gen healthcare companies will be built within the interstitial spaces between entities, not solely focused on a single stakeholder,” as noted on X by Morgan Cheatham, Vice President at Bessemer Ventures.
For digital health startups looking to tap into network effects and platform business strategy, the good news is there are options.
Among these options are digitizing interactions between healthcare stakeholders and enabling novel new transactions.
We’re proud that Syntax is recognized as one of these leading-edge digital platform companies designed to enable VBC success and unleash potential and profits.
Our solution helps organizations get unstuck by doing four things well:
Identifying the best fit payment model designs for each partnership.
Promoting contract standards and understanding the impacts of proposed deals.
Providing measurement and ability to adjust in real time.
Creating trust through collaboration and transparency.
We believe this is what VBC needs to deliver for your organization. Let me know if you agree—are digital collaboration tools the key to VBC success?
Rachael Jones is the founder & CEO of Syntax Health and a thought-leader in Healthcare Payment Innovation, Analytics, Product Development, Commercialization & AI Solutions