Will Innovation Capture Value-Based Market Share?
- April 14, 2021
Value-based care and transitioning healthcare from a high-cost, volume-based marketplace into a quality-focused, preventative care marketplace are hot topics within our normal news cycle. Although value-based initiatives have been around for years, the past decade has seen the most significant push towards this paradigm.
Value-Based Care Today
The healthcare marketplace is shifting toward value-based incentives in both the governmental and the private sectors and areas where they come together. Below is a smattering of the payment models that have emerged within the traditional healthcare delivery system.
Medicare/Governmental | Medicare Shared Savings Program (MSSP), Medicare accountable care organizations (ACOs), and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which includes alternative payment models (APMs) and the Merit-based Incentive Payment System (MIPS).
Commercial Payors | Clinically integrated networks (CINs), bundled payments, shared savings and losses, capitation, value-based metrics tied to incentive dollars.
Healthcare Providers | Consolidation of hospitals/health systems and creating CINs, coordination of care, preventative care, access to health information, primary care medical homes, chronic care management, telehealth.
Employers | Partnering with healthcare providers for specific services and procedures under a bundled payment or capitated model (e.g., Wal-Mart, Cleveland Clinic).
Telehealth | COVID has accelerated the use of telehealth and enacted changes to the regulations around telehealth services.
A significant emphasis has fallen on primary care for value-based initiatives, as this area can impact the entire care system through coordination of care and preventative measures.
The focus on primary care has led to innovation in the space and investment from non-traditional healthcare sources. There is considerable opportunity for development in the value-based space as many markets are only recently branching into the area with any significance. The new activity will continue to progress, and private enterprises will innovate to capture market share from traditional healthcare solutions.
Thus, it is imperative to think ahead about how your patients will consume healthcare and modernize to deliver solutions they will consume. Below is an example of an emerging company and its impact on traditional care delivery.
An Emerging Alternative: Forward Health
Started in 2016, Forward Health is a primary care business model aiming to “improve how healthcare works in order to lower costs, improve results, and make quality care available to those who need it most.” Forward Health is a membership-based primary care service focused on patient experience, transparent costs, and preventative care using the most up-to-date technology and testing to provide both the physician and the patient with information to improve and maintain long-term health.
Forward Health charges a monthly fee of $149 for a minimum membership plan of six months for all of the following services:
- Unlimited in-person doctor’s visits with their employed physicians
- Biometrics monitoring
- 24/7 messaging
- Blood testing
- Genetic analysis
- Skin cancer screening
- Mental health support
- Men’s and women’s health
- Rx delivery
- COVID-19 testing
Some of the services may be one-time services (e.g., genetic analysis) or annual services (e.g., cancer screening); however, whether the service is one-time or recurring, the monthly fee remains the same.
Unlike standard medical office visits, Forward Health does not charge or work through your health insurance provider. The monthly fee is out-of-pocket, and one heavily touted benefit is that you can use an FSA or HSA to pay for the membership.
Thus, the value proposition Forward Health puts forth is based on the consumer experience. They are selling state-of-the-art technology paired with transparency and patient interaction to provide consumers with improved long-term health. As many are aware, this addresses some of the major pain points facing the healthcare marketplace today.
While other forms of care, specifically value-based care, have been brought to market, many have failed or have been absorbed into the traditional medicine marketplace. Forward Health stands out for two reasons, in particular: investment capital and leadership.
Forward Health was initially launched with $30 million in financial backing and recently garnered $225 million in series D round funding as it continues to expand its presence throughout the U.S. Although the healthcare market is known for considerably large dollar ventures, this amount of financial support for a market-disrupting company is significant.
The investment amount alone is worth noting; however, those investing in and advising Forward Health draw even more attention to the startup. They are a mix of healthcare leaders, technology industry leaders (notably Google/Alphabet), and other wealth angel/VC investors. They are all influential experts in their respective fields and understand the startup company lifecycles.
Although Forward Health is still in the early stages of business, it checks many of the perceived “boxes” to be a successful marketplace disruptor in an industry where change has been traditionally slow.
Impact on the Marketplace and Areas of Opportunity for Traditional Healthcare Providers
The publicity and focus on healthcare’s hot-button issues, combined with the investment dollars entering this space, make the primary care value-based care model a prime target for market disruption. The average consumer finds healthcare to be costly and difficult to navigate. Forward Health and similar models target consumer pain points with financial capital, modern technology, and specific consumer target markets.
Forward Health does not currently have plans to enter all geographic markets or sociodemographic areas. They have targeted large metropolitan areas in which they can likely grab market share through consumers willing to pay out-of-pocket in addition to their insurance costs or through those with funds in an FSA or HSA.
Traditional Medicine’s Solution
Although hospitals and health systems may not be able to replicate the Forward Health model exactly, taking the key aspects and applying them to some primary care groups could prove helpful to:
- Keep progressing the transition to value-based care as more payors and contracting focus on value
- Maintain primary care market share
- Garner new sources of revenue
If hospitals and health systems can be more flexible and innovative, they will play an essential role in maximizing their value-based care models and revenue from these models. Adding care models that appeal to those more focused on the consumer experience and long-term preventative health only adds to the breadth of services within the care continuum for most hospitals and health systems.
- Read more about incorporating value-based metrics into a physician compensation plan
- Learn more about our value-based care and reimbursement services
- Request to speak with Andrew Cadger to learn more about how Coker Group can help adapt your services for value-based care