The latest research from our team
Download the latest edition of Protera Insights for leading medical care insights from the Protera Health Team
Download the latest edition of Protera Insights for leading medical care insights from the Protera Health Team.
If your health plan does not measure each of the three components of the value equation and use those measurements into decision-making analysis and key priorities, your plan cannot optimize VBC delivery.
Musculoskeletal (MSK) conditions are consistently top cost drivers for health insurance plans, self-insured employers, and risk-bearing provider groups. These costs are driven by high disease prevalence (1 in 2 adults in the United States are affected) and overutilization of costly procedures and surgeries (up to 30% of these being inappropriately performed). Over the last decade, a number of digital health solutions have appeared on the market with the goal of helping lower costs for – in particular – employers by improving access to exercise therapy.
Spearheaded by the Affordable Care Act 1 , value-based health care has taken center stage in American health care. The traditional payment environment of fee-for-service care has resulted in insurmountable costs to health plans and self-insure employers, which bear financial risk for their members and beneficiaries. Payment reform that priorities value (high quality outcomes with low costs of care) has enjoyed largely bipartisan support 2 due to the importance
In many value-based arrangements, a majority of the expenditures is the result of specialty care. However, most specialists are paid almost exclusively through a fee-for-service payment system, which prioritizes volume of care delivered as opposed to value delivered. Therefore, specialty care expenditures directly impact performance in value-based programs. This is especially relevant for musculoskeletal (MSK) conditions, which affect over 50% of all American adults.
