Plotting a Roadmap to Success in Value-based Care

Stepping into an unknown territory comes with its own set of apprehensions and fears. The same goes for the providers who are or will be transitioning from a fee-for-volume to a value-based system of care. Providers are encouraged to focus on streamlining operations, optimizing technology and improving patient communication and making the clinical changes necessary to transform the way they provide care. However, value-based care is still in its infancy and its adoption has been slower than expected, owing to lurking doubts, questions, and misconceptions. How can providers not only adopt VBC but also succeed in providing quality care?

Getting started with value-based care

The roadmap to value-based care can compel healthcare organizations to blend operational, financial, clinical, and other relevant data to gain insights into improving quality, control costs, and increase patient access. More than anything, it needs refinement of information technology and reshaping organizational structure.

Excellent data analytics, an integrated care management infrastructure and an efficient system for internal compensation, combined with a patient-centric vision are means to succeed in VBC.

The first step would be collecting, organizing and integrating all comprehensive digital medical data. The amount of data in healthcare goes as high as zettabytes, and all that is needed in this stage is value integration and quick access to this data to efficiently drive future outcomes.

The second step is using advanced analytics to understand and monitor the health of patients, the impact of care plans and the performance of the organization and to identify opportunities for growth and shortfalls. Moreover, a solid grounding in analytics can help in reaping the maximum benefits out of VBC. To put things in perspective, the U.S. healthcare spends more than $2.8 trillion on healthcare; and 30% of this spending can be accounted for wasteful spending. With the use of analytics, providers can identify trends, pinpoint overhead cost drivers and work on cutting down unnecessary costs in the future.

Since the focus of value-based care is the patient, the third step would be to analyze the needs of population health. VBC and PHM are linked closely together and to drive end-to-end value-based care, there has to be a significant focus on delivering care, improving quality and approaching population health with an integrated approach.

Now comes the daunting part. The fourth step would be for providers to look for insights into their investment needs, arrange their operations and then work on aligning incentives. Offering incentives and rewards to providers is integral to engaging providers and in turn encouraging them to provide efficient and effective care to patients.

The fifth step and the most crucial step is to provide care. The entire idea behind value-based care is to create a new paradigm that emphasizes on the responsibility of coordinating care with a patient-centric approach, improve risk bearings and quality outcomes. Offering patients timely information about their health and treatment is a good tactic to keep them engaged in their care, make them an active part in the matters of their health and to maintain a good physician-patient relationship.

The sixth step should be to ensure a proper utilization of resources and reduce network leakages. Studies show that leakages cost health systems between $78M to $97M per year, attributing for about 55-65% of their revenue loss. It’s of paramount importance that network leakages are reduced to a minimum and healthcare organizations on maximizing their resource utilization, increasing productivity and reduce any misalignment between preferences.  

The seventh and the final step would be to monitor and assess performance, identify shortcomings, and address them. It’s important that healthcare organizations continually monitor the performance of their organizations, track their outcomes and identify areas for improvement. This would not only help providers understand the gaps in care but would also increase physician buy-in and provider engagement. Just like patients, engaging physicians by keeping them informed will help climb another step in the VBC ladder.

Challenges along the way  

The challenges that hinder the path to transitioning into VBC may not be daunting, but can’t be overlooked. The biggest challenge is that information pertaining to patient and episode has been virtually inaccessible which may bring about errors and gaps. If one can’t see what is happening in a patient’s episode in real-time, there is no way one can manage patient health effectively.   

Another important element to deal within VBC is network leakages. A study conducted on referrals showed that only 35%-45% of adult inpatient care remained within a network, implying that over half of a health system’s patients receive care out of their network. Network affiliations, if not conducted properly can have serious implications on both the patient’s quality of care and the hospital system’s bottom line.

The road ahead

Value-based Care calls for better coordinated care, a measurable improvement in care quality, more risk-sharing,  cost effectiveness, and increased patient engagement which inevitably leads to complete patient satisfaction. True, there are apprehensions and value-based care comes with its own set of challenges, but the merits far outweigh the risks involved.  

However, it’s a long way to go. Providers will need to work together with payers in order to attain healthcare data that will in turn help with their population health management programs. There should be a clear understanding of risk bearing capabilities, shortcomings in practice, other sources of revenue, and payments models to choose.

As for the rewards, they manifest themselves in the form of better clinical outcomes. For any organization to succeed with value-based care, it is most important to keep the patient at the center of every decision and process. Healthcare was never a work of guesswork and random prescriptions. Value in care is not a new notion. The path to value-based care is not a difficult one but calls for multi-pronged, long-term efforts. Only then can we come close to realizing the dream of an accessible, affordable and equitable healthcare.

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