In a typical scenario where a social worker is contracted by a VBC network to inform patients identified with SDOH needs of available services, the layered integration described above would allow the health system and/or payer partner(s) to confirm the “closed loop” on the social worker referral. This is accomplished by obtaining the service completion documentation electronically as well as a detailed invoice from the CBO – both digitized to extract and store the required information. With the verification of service delivered on file and available for authorized partners to view, payment of the digitized invoice can be automated.
Expanding care outside the four walls
Despite the disruption from the pandemic, the value-based care market is expected to grow by 15% per year through 2025, reaching $4 billion. It is likely that the pandemic accelerated the adoption of such care models as providers invested in telehealth and other ways to manage patients remotely. As use of VBC programs grow in the future, health systems need to include CBOs in their networks to prospectively manage risk using the captured SDOH data and the resulting enhanced network performance. To fully capitalize on the value and achieve the awaiting promise of lower cost with improved outcomes, health system and payor partners will also need to support CBO service delivery by digitizing functions like invoicing and compensation by adding this layer to existing infrastructures.
About the authors: Lynn Carroll is the chief operations officer, and John Schwartz, the chief revenue officer, of HSBlox, which enables SDOH risk-stratification, care coordination and permissioned data sharing through its digital health platform.
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