A Focus on Quality Drives This Successful Value-Based Care Program

Data shows value-based care leads to better and more equitable health outcomes, increased patient and care provider satisfaction, better access, and more affordable care. When delivery and payment models are aligned around quality of care rather than quantity, they drive better health outcomes and help curb overall healthcare costs. And those outcomes are even better when health plans and care providers make it a point to share data-driven insights and collaborate to close gaps in care.

A longstanding partnership between TriHealth in Greater Cincinnati and Elevance Health’s affiliated plan in Ohio proves how a value-based care delivery and payment methodology has successfully moved to a quality-based model from a traditional volume-based focus.

TriHealth and Elevance Health’s affiliated Ohio plan launched an advanced value-based care arrangement in 2019, building on a decades-long history of collaboration. Results demonstrate the power of this partnership, from catching serious conditions earlier because members receive recommended screenings to better management of chronic conditions like diabetes, heart disease and hypertension.

“We’re proof that this works,” said Mark C. Clement, president and CEO of TriHealth. “When a health plan and a provider network work together like we’ve done for the past five years, and the outcomes are this good, it’s clear we can all get more out of healthcare when we focus on value.”
 

Value-Based Care Model Outcomes Speak for Themselves

TriHealth patients who were covered in 2022 by Elevance Health-affiliated plans received preventive care at rates that rank in the top 20% of all care providers in Elevance Health’s value-based care program. For example:

• 90% of infants and 76% of patients aged 3-21 received preventive well-child visits
• 72% of adults received recommended colorectal cancer screenings
• More than 70% of patients got recommended blood pressure control screenings*

Other indicators that showed TriHealth patients covered by an Elevance Health-affiliated plan received the right care at the right place included reduced acute care admissions, fewer people readmitted within 30 days of being discharged, and reduced emergency room use.
 

Beyond the Contract: Value-Based Care Delivery Tactics that Boosted Success

On top of incentives and a solid partnership, specific initiatives contribute to the success of these value-based care arrangements. The health plan’s Health OS digital platform helps enable data-driven insights to inform treatment decisions. Health plan provider success teams work directly with TriHealth clinical leadership to analyze and share data, identify process improvements, and deliver evidence-based care. The health plan’s coordinated care management recommendations and actionable data support TriHealth’s direct, timely preventive care for patients with chronic conditions.

“Together, TriHealth and our affiliated health plan in Ohio have established a highly successful value-based care model, focused on collaboration at many levels, that lays out a road map for the health system of the future,” said Dr. Catherine Gaffigan, president, Health Solutions, Elevance Health. “As we accelerate both the number and sophistication of these types of collaborations, we expect to see continued improvement in health outcomes for members, reduced administrative burden on care providers, and lower cost trends overall.” 

*Source: Most recent internal quality data.