Shift from Volume-based Care to Value-based Care: Opportunities and Challenges

The goal of Value Based Care (VBC) is to provide patients with better care that focuses on providing solutions and monitoring improvement in health. Value-based payment ties together outcomes, total cost, and cost efficiency as the components of a care plan. Under the value-based care model, Physicians will spend as much time and resources as necessary on each patient according to their needs rather than following a predetermined schedule.

This Volume-to-Value Transition (VVT) in healthcare delivery incentivizes improved health, curtails the effects of chronic conditions, and follows evidence of the efficacy of various treatments. This shift is also putting pressure on healthcare organizations to compete on value. Healthcare Organizations need support from integrated delivery systems to make the shift from volume to value based care. A system that can manage pluralistic care and payment models to ensure value to both risk-based and traditional fee-for-service contracts customers. It needs to balance the existing volume-based models with a growing emphasis on value.?

Different organizations are in different phases of the journey from volume to value, and at same time the policies continue to evolve. In response, the health organizations need to sustain Fee for Service (FFS) revenue as they follow guidelines and strategies to be increasingly ready to deliver value based care. This transition involves some opportunities as well as some challenges, let us look at some of those…

Opportunities

Reduce waste in health care : Waste is not just ordering too many supplies but more than that. It can include over-diagnosis, unnecessary diagnostics, and unnecessary surgery. The tests that turn up many false positives and expose patients to unnecessary risks. It costs a lot of money and causes worry for patients without leading to improved outcomes. Having more transparency between provider and patient and shared decision-making can reduce this waste to a great extent. As Value Based Care focuses on preventive healthcare and achieving positive patient outcomes in a cost-effective manner, it eventually reduces the overall healthcare expenses.

Multispecialty group practice: This brings an opportunity to differentiate among potential provider groups in an already fragmented Fee for Service (FFS) market. Value based care is a team based approach and not necessarily the sole responsibility of a physician. This brings huge power to the system. We now have a bigger care team of physicians, medical assistants, nurses, care coordinators, social workers, mental health practitioners, and others as well as volumes of data from EMRs, quality measures, claims data, and other sources and combining these data can give us great actionable insights. This also helps to improve the patient engagement with a bigger care team, encourages shared decision-making and ultimately improves the nation’s health index.

Challenges

?The shift from a well-established fee for service model to fee for value model is not as simple. Logistically it is quite complicated, and if not implemented properly, value-based care can carry high failure risk to providers and health care facilities. Some of the common challenges to value-based programs include:

Provider Engagement - In a time when everyone is talking about Patient Engagement, we are ignoring an important aspect here, especially in the context of Value Based Care, which is provider engagement. Physicians are no longer the sole providers of care. They are now members of a team working together to deliver high-quality, highly coordinated care for patients. In this model, physicians, medical assistants, nurses, care coordinators, social workers, mental health practitioners, and others are practicing at the top of their license. A team-based model has multiple benefits but at the same time, it is full of challenges if not handled properly. It is very important to have a clear division of roles and responsibilities and an integrated and transparent system to access complete patient details. Failing to do this can lead to care gaps, rising cost and risk to patient health.?

Aligning physician incentives with value delivered: It is not so simple to build incentives into physician contracts that reward them for keeping people healthy. This problem is made worse by our current limitations in defining what high quality care should look like and how to measure quality vis-à-vis outcomes and Key Performance Indicators, for a given disease.

Consistent care delivery: The diagnostic/treatment protocols and patient outcomes vary between different medical institutions/individual practitioners. This inconsistency may result in fragmented patient outcomes, which in turn, results in lowering the care quality at a population level.

Data, analytics and IT tools: Many health systems struggle to obtain relevant, accurate and timely data and use that data to implement an institutionalized value-based care model.

There are definitely some glaring challenges in the face of shifting an existing volume based system to value based care for patients. However, the advantages of moving to value based care far outweigh the challenges. This calls for a collective effort from all healthcare organizations to work towards implementing a system that creates more value and considers patient-centric solutions.???

?Authored by Pankaj Ojha, Director, Technology, IKS Health. Pankaj comes with 17+ years of Tech Leadership experience in Healthcare IT. At IKS Health, he leads the tech initiatives for Value Based Care (VBC) and Clinical Support feature clusters.