Value-based payment (VBP) models have a good chance of taking off in the health insurance space if initiated by the bigger players, said Dr Dennis Sebastian, Regional Director - Health with RGA Reinsurance Company Middle East in a webcast.
Under VBP, healthcare providers are paid for quality and outcomes instead of the quantity or amount of care they provide. The model is a change from the traditional fee-for-service model, which incentivises providers to give more care and thereby increase healthcare spending, to paying them for achieving goals and thereby reducing wasteful spending.
VBP is still nascent in the region with concerns around who will bear the costs of the transition from the dominant fee-for-service model, data capture and collection, and IT costs, said Dr Sebastian. However, with some larger providers such as Daman and Bupa Arabia already taking the lead in implementing such models, this should drive an industry-wide adoption of data analytics. This, in turn, could get both payors and providers on “the same table and narrow the challenge of implementation a little more”, he pointed out.
Mr Daniel Whitehead, Director of Medical Strategy at The National Health Insurance Company – Daman, said that behavioural analysis through the implementation of VBP, whereby providers are scored on performance and the worst are targeted for interventions, has resulted in “several millions of dirhams saved”. Although VBP in Daman is still in its early stages, the long-term goal would be to see an improvement in the quality of care, he added.
Business intelligence and analytics are essential in VBP, whereby engines have to be fed with not just data from claims but also evaluations, clinical outcomes and processes, said Mr Frans Elberse, Director of Business Development Health Insurance, Oracle. Change management and implementation are key challenges for insurers and it will take some time for providers to all get on board, he noted.
The webcast was organised by Middle East Insurance Review and sponsored by Oracle.