Using AI in the Era of Value-Based Care

Patient Care Patient Engagement Patient Support Programs

Enter the Era of Value-Based Care

In recent years, rising healthcare costs have prompted a shift from fee-for-service payment models to pay-for-performance, or “value-based,” reimbursement. Alternative payment models have transformed healthcare as we know it, with more payers reimbursing pharmaceutical companies, pharmacies, and providers based on quality rather than quantity.

Explore below to learn more about value-based care and how artificial intelligence (AI) can optimize value-based initiatives.

Value-Based Care is Here to Stay

The wave of value-based care is supported by several factors:

Rising healthcare costs

As the cost for medical treatments rises, consumers are looking to reduce potentially arbitrary or unnecessary tests and procedures. Value-based care aims to treat illness as it occurs, providing the right care at the right time, and at the right place.

Patient empowerment being at the core of value-based care

Patients want to see the value they’re getting for what they’re paying, especially with the average out of pocket cost for care rising over the years. Value-based care models can improve the overall quality and value of healthcare being offered, giving patients access to more empowering options.

Rapid adoption of virtual health

The advancement of technology has allowed for electronic health records, telemedicine, and remote patient monitoring. This helps providers access and share patient information more easily and effectively, reducing the need for redundant tests or inconvenient in-person visits.

Value-based contracts have ultimately changed the game, incentivizing numerous healthcare organizations to address gaps in therapy, improve care quality, and achieve positive patient outcomes. 

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Value-based care initiatives for pharma

Because pharmaceutical companies are involved in risk-sharing agreements with payers, these arrangements have encouraged more pharma companies to introduce patient support programs designed to properly educate patients, reduce barriers to adherence, and achieve better health outcomes.

In fact, 53 percent of patients surveyed say that they want more education to better understand their medications – and more than three quarters of consumers go so far as to say they feel that pharma companies have a responsibility to provide tools and services that complement their products.

This may sting for patient support program leaders who have spent considerable time and resources to deliver outstanding programs and still see consumers wanting more. Historically, pharmaceutical companies have spent more than $5 billion on patient support programs every year, but fewer than one-quarter of patients (23 percent) say they are extremely or very familiar with patient support programs.

As we’ll explore next, artificial intelligence (AI) can be the powerful, effective bridge that is necessary for success going forward.

Embracing AI Technology to Enhance Value-Based Care Initiatives

How can healthcare organizations embrace value-based care and achieve their goals? AI is the answer. AI technology leverages robust, varied datasets to make predictions for the next-best-action. These datasets are pulled from a range of sources, including social determinants of health (SDOH), medical and pharmacy claims, historical engagement data, consumer behaviors, and more.

AI-powered predictions empower pharma companies to:

Predict High-Risk Patients in Need of Support

Using AI, pharma can accurately predict which patients have the highest risk of medication non-adherence or may be experiencing a gap in therapy. Additionally, AI technology can hone in on patients who are most likely to be positively influenced by an intervention to achieve optimal results.

By investing in AI, pharmaceutical organizations can effectively target and engage the right patients, which directly contributes to cost-savings and progress toward meeting performance goals and maximizing performance-based reimbursements.

Deploy Personalized, Cost-Effective Interventions

With a better idea of who to target, interventions are sure to be more effective—but that’s not where the AI benefits end. Healthcare organizations can also turn to AI to personalize patient interventions and achieve optimal results at a lower overall cost.

AI can personalize patient interventions based on the ideal channel, messaging, and timing for each individual. For example, some patients may need high-touch interventions such as phone calls, whereas others may benefit just as much from low-touch interactions such as emails.

Maximize Value-Based Care Programs with AllazoHealth’s AI Platform

Whether you’re trying to maximize the cost-efficiency of your strategic initiatives or investing in patient support programs to meet pay-for-performance measures, AI can help.

Numerous pharma companies, pharmacies, and payers use AllazoHealth’s AI platform to optimize patient support programs and enable effective, personalized interventions that improve patient engagement and health outcomes. Schedule a demo to see how AllazoHealth’s AI platform can predict which patients need support, personalize patient outreach strategies, and maximize your value-based performance.

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