Welcome to the Empowered Patient Podcast with Karen Jagoda. This show is a window into the latest innovations in applying generative AI, novel therapeutics and vaccines, and the changing dynamics in the medical and healthcare environment. One focus is on how providers, pharmaceutical companies, and payers are empowering patients. In addition, conversations are often about how providers, care facilities, pharmaceutical companies, and payers are being empowered by technology to improve patient outcomes and reduce friction across the healthcare landscape.
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- Virtual and digital health
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Mar 30, 2022
Lynn Carroll is the Chief Operating Officer at HSBlox and is in the business of helping payers and providers move from a fee-for-service to a value-based model. One of the critical challenges in scaling these solutions so that they can work with legacy systems and provide data and performance metrics to determine and improve outcomes in the value-based arena.
Lynn explains, "So, as we think about the overall landscape of healthcare that traditionally has been on a fee-for-service basis, the legacy systems on both the payer and provider sides have been geared toward billing and transactional mechanisms. Submitting claims and getting paid based upon those claims is a very fragmented approach."
"And what we have noticed is that the ability to operationalize these value-based programs with the legacy system is a challenge. Both hierarchically in terms of which providers are participating, what population is assigned, but also in the funding pool management, whether they're from employers, from commercial payers, from Medicare Advantage, or state programs, Medicaid, children's health. Keeping the funding pools straight, managing the associated risk corridors, and then ultimately reporting performance is not how the traditional systems have been geared in the past."
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