Four ways real-time benefit supports value-based care

Monday, June 22, 2020 | By Jonathan Bollinger, Product Manager

Four ways real-time benefit supports value-based care

In a post-COVID world, it will be more important than ever for health plans to embrace a value-based care transformation that helps to achieve the quadruple aim (1. cost control, 2. improved clinical outcomes, 3. member satisfaction, 4. provider satisfaction). Health IT is at the heart of this transformation, but transformative technologies and systems such as artificial intelligence, machine learning and interoperability are still catching up with value-based goals and aspirations. 

Health plans interested in delivering value-based care sooner rather than later do not need to wait for health IT to evolve to begin making value-based improvements. Real-time benefit services are available today that can drive price transparency, quality care and member and provider satisfaction. Here are four ways real-time benefit services help support value-based care.

1. Real-time benefit services support providers who are participating in alternative payment models (APM) through price transparency.

If health IT is like the heart of value-based care, then value-based contracting is the backbone, and value-based care success depends on both. If plans want providers to participate in value-based contracts that involve downside risk, they must be able to deliver accurate, detailed and actionable member information in a timely manner.

One of the most important things plans can do as they facilitate APMs is to make it extremely easy for providers to clearly understand the plan’s cost for a drug. Real-time benefit services accomplish this by allowing users to compare member-specific cost information for up to four medications at the point of care so they can make informed, value-based decisions.

Graphic shows drug price, channel, name, and other sample member details


Fig 1: In this example, we see the therapeutic alternatives returned from an example real-time benefit request. Notice how the provider can compare options that are specific to that member’s prescription benefit. A 90-day supply of 10mg dexmethylphenidate tablets is a more cost-effective choice for the plan and the member.


2. Real-time benefit services help providers support adherence that can lead to positive clinical outcomes

With real-time benefit services, providers and members can work together to choose a medication that is appropriate for the diagnosis and that the member can afford. When patients can afford their prescriptions, they are more likely to fill them, and increased medication adherence is associated with improved clinical outcomes[1].

So, do real-time benefit services impact adherence? Studies have repeatedly shown rates of primary non-adherence as high as 28-30%[2],[3]. When prescribers used SS&C Health’s Real-time Benefit Service to inform prescribing decisions, plans reported a 20%-21% rate of primary non-adherence.

3.  Real-time benefit services can enhance member satisfaction

Real-time benefit services equip providers to support member satisfaction, which is a major tenet of value-based care.

Research[4] shows that the ability to “talk cost” with providers is an important factor for a high percentage of patients. With the price transparency that is available through real-time benefit services, point-of-care conversations can get very cost-specific. Members can come away knowing precisely what out-of-pocket costs will be for the prescribed drug, how the choice compares to other therapeutic alternatives and how the prescribing decision impacts their deductibles or out-of-pocket maximums. All of this helps to deliver value and a satisfying experience for members.

4.  Real-time benefit services support provider satisfaction

In addition to being a destructive force in the personal lives of providers, provider burnout contributes to reduced care quality, decreased member satisfaction and higher healthcare costs.[5] A major contributor to burnout is “bureaucratic tasks.”[6] Medical practices complete an average of 29.1 prior authorization (PA) requests per week per physician with staff spending about 7 hours on each PA.[7] This puts work that is associated with PAs squarely in the “bureaucratic task” bucket.

With real-time benefit services, should physicians request a drug that requires a PA, they are alerted immediately in the workflow. They are also shown therapeutic alternatives that do not require a PA when one is available via the member’s benefit, giving them the opportunity to change drugs as appropriate.

Sometimes, however, these drugs are the best clinical choice. From the provider’s vantage point, real-time benefit services integrate seamlessly with electronic-PA (ePA), which automates the PA submission process. Providers can submit ePAs during patient encounters and frequently receive electronic responses in minutes, eliminating bureaucratic PA-related tasks that can take hours. Additionally, members who need these drugs will experience faster times to therapy ­—another step toward improved quality that sets a member up for more positive outcomes.

To learn more about real-time benefit services and how to evaluate a potential partner, download our whitepaper, Real-Time Benefit: Validating Outcomes and Savings for Health. To learn more about value-based care, download our new whitepaper Four ways to accelerate Value-Based Care for Health Organizations, or contact us.


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