The Future of Value-Based Health Care: AI and Beyond

Robert Groves, MD is a seasoned health care professional with over 30 years of diverse experience, from private practice to delivery and payer systems. As executive vice president and chief medical officer at joint venture health insurer Banner|Aetna, he’s introduced revolutionary technology and programs that simplify care, reduce costs, and boost accessibility. He’s a podcast host and often contributes thought leadership to conversations on emerging industry topics, including health care AI.

This blog is based on a conversation between Dr. Groves and Megan Antonelli of HealthIMPACT Live that explores the intersection of value-based health care, AI, and more.

When it comes to health care costs, the U.S. spends two to three times more than other developed countries yet experiences worse outcomes. In response to this growing financial and health burden, stakeholders across the industry have developed new strategies to curb costs and improve care quality, including value-based care (VBC) payment models.

What is value-based care?

Value-based care emerged as an effective tool for achieving better outcomes and controlling excess costs in health care. Under VBC arrangements, the payment model is fundamentally shifted to make providers more accountable for health improvement while also giving them more flexibility to deliver the right care at the right time. Rather than being paid for the volume of services provided (as in the traditional fee-for-service model), payment is tied to outcomes. In other words, when patients get healthier and stay healthy, providers are rewarded.

Joint venture health insurers, including Arizona-based Banner|Aetna, are the most evolved types of health plans on the VBC continuum and have the greatest potential to improve outcomes and lower costs. By splitting responsibility for profit or loss evenly between payer and provider parent organizations, joint venture health plans incentivize both entities to collaborate toward health and member experience improvement. However, there are less than a dozen joint ventures nationwide due to the complexity of the model. Banner|Aetna is one such example, with oversight and accountability shared equally between Arizona’s leading health system Banner Health and national insurer Aetna.

Pushing value-based care forward

Another force driving the evolution toward VBC is artificial intelligence (AI). Though the technology is still in its early stages, health care AI is already being harnessed to advance quality, efficiency, and cost goals. For instance, technology like computer vision can help diagnose dermatological conditions by analyzing complex imaging exams with impressive accuracy. Another notable application is the use of health care AI to prioritize radiology images, which improves the patient experience by reducing the time to diagnosis. Banner Health is also using AI-powered automation to optimize operating room scheduling thus enhancing operational efficiency. Initial results show improved resource utilization, which means patients received care more quickly with less hassle.

From a value-based care perspective, AI-powered solutions like these examples help patients receive timely and precise care, which is essential for the success of VBC models.

Health care AI challenges and considerations

While health care AI has the potential to revolutionize the industry, physician and thought leader Dr. Groves emphasizes the importance of maintaining human relationships, even as technology becomes more prevalent. According to Dr. Groves, the focus of AI should be to support and enhance the physician-patient relationship, not replace it; otherwise, providers may face increased workloads without corresponding improvements in patient outcomes. “We’ll simply end up seeing 40 patients a day instead of 20 because AI will dramatically improve our efficiency. I think that's a mistake,” he notes.

Looking ahead, Dr. Groves foresees health care AI playing a large part in driving industry improvements, but he stresses the need for systemic changes towards VBC to fully realize AI's potential. “If we don't change the compensation model, then we're not going to get what we want out of AI,” he said. Without breaking away from the current fee-for-service system, it will be difficult to leverage AI to effectively improve patient outcomes and enhance human relationships in health care.

By moving toward VBC and using AI to enhance the physician-patient connection, the health care system can become more efficient, effective and compassionate. Listen to the full HealthIMPACT Live interview hosted by Megan Antonelli for additional insight from Dr. Groves on the convergence of VBC and AI in the health care industry.