Gaining a Foothold In Value-Based Care
Providers who gain a foothold in value-based care today will be better positioned for the future of care delivery.
Value-based care is a healthcare delivery framework that incentivizes #healthcareproviders to focus on the quality of services rendered, as opposed to the quantity. Under a #valuebasedhealthcare model, healthcare providers (including hospitals and physicians) are compensated based upon patient health outcomes.
Delivering High-Quality, Value-Based Care (VBC)
No matter the sophistication or experience of the organization, it requires optimizing two different infrastructures: (1) systems to handle #feeforservice claim processing and (2) investing in and implementing the HIT required to achieve value-based care metrics.
The national focus on price and value will increasingly push providers to take on more responsibility when it comes to utilization and cost, and a majority of value-based relationships could include both upside and downside risk.
A proactive response will protect against obsolescence in the future of value-based care. Doing so will require systems to invest in integrated care teams, the right incentives and data tools.
- Integrated Care Teams. An integrated care team would ideally represent inpatient, outpatient and primary care providers, including nurses, general practitioners, hospitalists and clinical pharmacists, as well as case-specific clinicians, such as physical therapists or behavioral health providers, all dedicated to care coordination (VBC).
- The Right Incentives. When it comes to working with private payers, providers should seek out arrangements that set them up for success. They can work with payers to clearly identify the targeted population(s) and service(s), arrive at a shared definition of value and determine the appropriate level of risk or reward to take on.
- Data Tools And Technology Resources. Value based care requires providers to assume a mindset in which everything is potentially improvable. A number of technology vendors have emerged with solutions that give providers access to real-time clinical data which helps them manage care more efficiently.
Implications and Recommendations For Healthcare Organizations
There’s no doubt the healthcare system of the future will continue to place substantial emphasis on quality, costs and holding providers accountable. Some recommendations:
- Understand That Value Isn’t An All-Or-Nothing Proposition. It’s unlikely that the healthcare system will complete a full-transition to value-based reimbursement model in the next decade, but it is also unlikely that payers seeing success in both quality and cost outcomes will reverse course.
- Look For Competitive Advantages. Payers look poised to tie more reimbursement to value, which will likely accelerate provider transitions. But there are other business reasons to build a foundation for value-based care. As consumers demand more patient-oriented care, quality and patient satisfaction will have tangible competitive advantages.
- Update Your Technology Plan. The digitization of data, better cloud-sharing and the advent of AI mean that technology investments must be strategic. Systems can plan and time their investments to address pressing needs while preparing for future advancements.
How to Implement Value-Based Healthcare
If you are a healthcare professional, there are steps you can take to begin implementing value-based care in your practice. According to the American Medical Association (AMA), there are five steps healthcare providers can take to prepare their practices for value-based care:
- Identify your patient population and opportunity;
- Design the care model;
- Partner for success;
- Drive appropriate utilization, and;
- Quantify impact and continuously improve.
Summary
Provider organizations are now facing pressure to take on real risk in these value-based arrangements. A number of factors – including bipartisan support for value-based programming, the rise of Medicare Advantage and the demand from consumers for more convenient care, indicate that a future in which health systems are held accountable for patient outcomes is inevitable. #healthcareproviders #valuebasedhealthcare #feeforservice
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References
American Medical Association: “A majority of physicians now take part in an ACO.” Published: 2019.
CMS: “Next Generation ACO Model.” Published: 2020.
CMS: “Medicare Advantage Value-Based Insurance Design Model Calendar Year 2021 Fact Sheet.” Published: 2019.