Chasing Value-Based Care: Finding the Right Path

Chasing Value-Based Care: Finding the Right Path

By Karthik Ganesh, Founder & Principal Consultant at Aikya Strategies

The challenge in evolving to value-based care is that there is no one-size-fits-all approach. Organizations are at varying levels of maturity in terms of how much risk they are willing to assume, and this can affect both their starting points and ultimate goals. For instance, some hospitals and health systems are early in their thinking, realizing that they are going to have to take on downside risk at some point to maximize revenue and effectively manage margins—but they are just starting to consider how to make this happen. Then there are the entities that are a little farther down the road, having a greater risk appetite and maturity with the process. Perhaps they’ve participated in a Medicare ACO or tested a health plan for their employees. Although these organizations have embraced a higher-degree of risk, they are still receiving fee-for-service payments and haven’t completely made the switch to value-based care. These are just two examples of where an organization could sit on the continuum, however, they reinforce the idea that every organization is going to have its own set of characteristics and requirements that will determine the best ways to reach its value-based care goals—whatever those may be.

Because organizations will have unique launch points, they are also going to have varying technology needs. Only in rare occasions does an organization have a blank slate. Much more likely is the scenario where a hospital has already onboarded a system that could enable value-based care, but it is missing key functionality. Or, maybe a health system needs to augment certain areas of what it is already doing well. In these situations, organizations shouldn’t implement an off-the-shelf solution that causes them to recreate the wheel. Instead, they should look for products, solutions and processes that plug into their existing ecosystems, meeting them where they are and guiding them forward.

There are some common elements

Even though every organization has a distinct set of value-based care requirements, there are fundamental components that all organizations should have. First, they must define a crisp strategy for where the organization is headed. In other words, what are the specific goals, what is the risk tolerance and what are the financial restrictions? This strategy document should also include a gap analysis that shows where the organization is as compared to where it wants to be. Next, a facility should generate a readiness assessment that demonstrates whether it is willing to close identified gaps and what it would take to do so. These two documents will inform everything from an organization’s launch point to its required financial investments to what is necessary from a technology perspective. No matter how far an organization is along the path to value-based care, having these strategy and readiness documents are critical to guide efforts and support momentum.

It takes more than just technology

Unfortunately, not all organizations take the time to craft the abovementioned documents. In their rush to shift to value-based care, many hospitals and health systems focus on implementing technology, hoping it will close some of the gaps. However, it takes more than an automated solution to make progress. Technology is merely an enabler, not the silver bullet. At the end of the day, a move to value-based care requires a cultural and behavioral evolution and that will only come with a multifaceted effort that involves an organization-wide commitment to transformational change.