Value-Based Care Can Revolutionize Health Equity — Karen Walker Johnson
In the vast industry of healthcare, providers and payers cooperate to facilitate and fund health treatment. Providers are the physicians, hospitals, or other healthcare professionals that provide care to patients, while payers pay for the treatments. Private payers are typically insurance companies, while publicly sponsored payers are government programs including Medicaid, serving socioeconomically disadvantaged individuals, and Medicare, serving seniors and the disabled. These parties must work together in order to improve patient health outcomes and combat the widespread health inequity in the United States.
An innovative problem solver and catalyst of change, Karen Walker Johnson is a compassionate healthcare executive with years of experience in hospital administration, health plan operations, Medicare, and Medicaid. We’re in conversation with her as she brings forth her knowledge and expertise to tackle healthcare disparities.
Karen — you have a wide breadth of expertise in the healthcare industry. How does your background give you the necessary perspective and tools to manage healthcare from any angle?
“I spent about half of my career on the provider delivery side — I started as a registered nurse, and after law school I continued working with hospital systems and physicians. Later I pivoted to the payer side, working in managed care companies in the commercial employer-sponsored space before shifting to the public sector, where I worked in the Medicaid and Medicare space. I’ve also managed organizations that provide post-acute care, such as hospice, skilled nursing or rehabilitation services, so I have a broad and deep understanding of the full, holistic patient journey.
“For healthcare organizations, I’m able to utilize my unique expertise in both the clinical-provider side as well as the payer side. When I work with providers, they appreciate that I can understand their challenges and values; simultaneously, I bring the “customer’s perspective”, seeing how payers can bring value to them outside of the obvious funding. I’m able to tackle issues with an understanding of each party’s perspective, seeing situations from all sides.”
What is the level of impact that payers have on health outcomes, and can they help us reach healthcare equity?
“Payers can have a significant influence on patient care and health outcomes. In our traditional healthcare system, services are provided by physicians or hospitals, and payers reimburse the providers for their costs. This model has rarely demonstrated a positive impact on patient outcomes and payers have begun to rethink how they contract with providers.
“In the last few years, we’ve seen a shift away from the cost-based fee for service provider reimbursement structure. Increasingly, payers are moving towards what we call value-based contracting or care. Rather than paying providers for their services after the fact, under the value-based system providers receive most of patient care costs before the service; in return, providers must demonstrate improved patient outcomes. Through this model, the responsibility of managing spending shifts to the providers, which incentivizes them to be economically efficient and prioritize patient quality outcomes. Patients have greater access to care, improved clinical outcomes and greater satisfaction.
“There are many reasons we don’t have health equity. We need providers who are willing to take the extra step to understand their patient, address social determinants, eliminate disparities and make sure their patient understands their care. I believe a paradigm shift will take place in the next few years as more payers opt for value-based care — a large step in the direction of health equity.”
Having worked on all sides of the healthcare industry, Karen Walker Johnson brings a vast and diverse set of skills and expertise to her leadership roles. She has focused her passion of leading teams to improve the health status of vulnerable populations. Devoted to exploring how healthcare disparities and social determinants play a role in individuals’ health, Karen actively explores new approaches to solve the healthcare problems of today. The knowledge and energy she brings to the table are an asset to corporate boards.
https://www.linkedin.com/in/karen-walker-johnson-68b8826/
