Health Costs

5 Stages to Success in Value-based Care

Sandeep Gupta
Fri 29 June 2018

The value-based reimbursement model is fundamentally changing healthcare and we can observe a different dynamic in physician-patient relationship. There is now increased focus on enhancing collaborations to culminate the entire care process into a better experience.

In light of these goals, the need and opportunity for value-based care has probably never been greater than it is right now. In January 2015, the Department of Health and Human Services (HHS) announced its intentions to link 50% of all traditional Medicare payments to a value-based reimbursement model by the end of 2018.

A call for fine-tuning strategies

Every organization has its own unique set of challenges as well as opportunities. Recognizing the right opportunities that can result in favorable outcomes for the organization is the first step in realizing the potential of savings. The challenge is to be realistic about what impact value-based activities can create and what is targeted.

Most organizations might have the resources to succeed in value-based care, but perhaps not the right strategic road map.

Value-based journey is a step-by-step process, one cannot hope for higher savings without getting the preliminary steps right. It’s like working on a high-rise building project, you need to have a strong foundation for it.

1) Opportunity Identification

Target the lowest hanging fruits first, and then aim for the tougher ones.

The most effective method to attract better financial and clinical outcomes is to strategically approach them. Before you start working towards a value-based transformation, find the direction to start with. Locate the areas where most opportunities lie for your organization to have a substantial impact on quality of care and savings.

2) Measurement and Reporting Framework

Never leave money on the table. Build a robust reporting framework to secure all reimbursements.

Building a structured framework for measurement and reporting along with predictive tools can prove extremely effective. It can have a direct impact on decision-making as it provides care teams with comparative information on what is secured and what needs to be improved.

In addition to this, drilled-down data analytics can do wonders in identifying region/facility/physician that might need support to enhance outcomes. They can also leverage a better technology infrastructure that can reduce administrative burden on them by automating reporting features.

3) Clinical Integration and Physician Engagement

Contextual information will play a critical role in driving value-based care. Having no access to it is like driving on a highway at night without any headlights.

There is ample evidence to suggest that greater involvement of physicians through the integration of clinical practices will improve overall efficiencies across an organization. Besides improvement in practices, greater engagement among physician practices will account for more integrated care, referral, and medication management. Happily engaged physicians will also lead to lesser rates of physician burnout, and in this way, collaboration of physicians and patients in the care continuum tends to increase value.

4) Patient Engagement

Empowering and educating patients to take responsibility for their own health is key to the success of any care program.

Patient engagement is a two-way street and requires providers and patients to work together, in a mutually beneficial manner, as partners. To truly engage patients into their care for improved health, we must neither expect a provider or a patient to crack it all by themselves nor allow such a one-sided effort.

Engaging patients is about creating awareness among them, so that they know what is best for them. So that patients and their families can be a part of decision making in patients’ care journey.

5) Practice Transformation

Primary care doctors need to be empowered with information and technology that can smoothen the care processes. Today, they are battling time and rising costs and in most likeliness will continue like this if we did not revolutionize primary care.

Physicians need a technology that can help them remain physicians! It is critical that they get all the information they need where they want. They should be relieved of the burden of administrative tasks, they should get more patient-interaction time. More importantly, they should be able to understand their patients easily, without any hassles.

The road ahead

When we talk about value-based care, we are visualizing a health care that is based on value not volume. Unlike the traditional model, value-based care is driven by data because value-based reimbursements are calculated by using numerous measures of quality, reporting to payers on specific metrics, determining the overall health of populations, and demonstrating improvement.

Therefore, there are certain criterias that are required of providers such as extensive data analytics capabilities, population health management programs, and the ability to successfully use electronic health records for documentation and reporting. Providers may also have to track and report on hospital readmissions, adverse events, population health, patient engagement, and more. Since these requirements are only regulatory and may help till a certain extent, it is the providers who need to reset priorities and take precautions to ensure high-quality care delivery.

The bottom line is, value-based care will lead you to making many more lives healthier and greater opportunities for shared savings, but for assured success in value-based care, there is no fool-proof formula and there can never be. For making a smooth transition into the modern care delivery model, providers need to have a concrete plan in motion to realize their quality-based goals and consequently, reimbursements.

Webinar by Dr Devid Nace, MD on Healthcare Interoperability

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