Navigating the transition from a fee-for-service model to a value-based care (VBC) approach can be a troublesome process for healthcare leaders. Here are a few methods to make the shift as effortless as possible.
Many VBC models reward providers with additional revenue if they meet quality, cost, and equity targets. But others involve downside risk, which can be a turnoff for some providers.
As healthcare organizations shift away from fee-for-service models toward value-based care, there is increased emphasis on measuring quality. However, determining the best metrics for quality can be challenging. Fortunately, healthcare leaders can use new digital tools to increase patient engagement and improve outcomes while decreasing costs.
For example, digital medicine includes:
- Scheduled and on-demand telemedicine.
- AI-enabled delivery.
- Remote monitoring.
- Consumer-level health data integration.
- Other methods to help patients navigate their healthcare journey.
These tools can be a great way to deliver individualized care, decrease physician burnout, increase access to healthcare, and improve patient satisfaction.
Additionally, one of the requirements for value-based care programs is for the providers to take on both upside and downside risks, which can help decrease costs. This model rewards providers who meet or exceed their quality, price, and equity goals. It also incentivizes providers to focus on preventive care and treat chronic diseases.
In addition, a big driver of cost reduction is preventing readmissions from hospitalizations. Quality measures such as effective and efficient care, reducing medical errors, focusing on patient-centered care, and providing better care coordination can reduce hospitalizations and readmissions. This is a win-win for payers and patients, who experience lower costs and more positive outcomes.
Incentives are one of the key ways value-based care can reduce costs. By paying providers based on their performance, insurers are incentivized to reward healthcare organizations that improve quality, cost, and equity while decreasing unnecessary use of high-cost forms of treatment such as hospitalizations and medical emergencies.
As a result, healthcare organizations are incentivized to focus on prevention and treating the disease at its earliest stages. This can help prevent or delay the onset of more severe and costly conditions and save patients time, money, and discomfort.
While reducing costs is an important goal, the overall concept of value-based care is about improving outcomes for individuals and populations. This is a much broader goal than simply reducing the number of expensive medical procedures, as described by the Institute for Healthcare Improvement’s “triple aim.”
The best-performing value-based care (VBC) practices utilize an integrated approach to patient management. This involves teams of physicians, nurses, therapists, and community health workers who work together to manage complex patients. These teams are supported by a robust technology infrastructure that allows them to record and share patient data, spot opportunities for greater care coordination or improved outcomes, and gain a more transparent view of each patient’s utilization pattern, including specialist visits, hospital admissions, and emergency department use.
Imagine a world in which patients are active participants in their healthcare. This isn’t a distant utopia, and it’s an essential component of value-based care. When patients become engaged, they’re more likely to follow up on health screenings and stay on top of their medical needs, resulting in better outcomes and lower costs. The guiding principle of patient engagement is to encourage patient-centered behavior by making information accessible and encouraging participation in their own health and healthcare decisions. Many studies show that people who are “activated” – they understand and can apply and use the information they’re provided – experience better health outcomes at lower costs.
To increase engagement, providers must offer educational resources and implement systems that help patients navigate the health system, identify their health priorities, and engage with their healthcare teams. Patient engagement also involves motivating the right behaviors from clinicians and other staff, such as helping them to feel more comfortable and confident in discussing their clinical options with patients.
Getting to true value-based care requires more than just rethinking how you deliver health services. It also requires new technology to help providers meet the needs of this emerging paradigm. Providers need access to technology that automates labor-intensive back-office functions, helps them manage complex, cross-continuum care, and effectively monitor patient outcomes. They need a platform that helps them share data with other partners and align on key metrics across the continuum of care. This can be particularly challenging for independent primary care practices that receive payments from various payers and value-based care programs.
Moreover, many of these practices need more time to devote to a transformation requiring them to rethink their operations and workflows and how they treat patients. They need clear financial incentives tied to specific outcomes and large enough to motivate them to succeed in this environment. These incentives should be delivered timely rather than waiting months for payments.
Finally, they need to be able to supplement their physicians with additional clinical staff, such as nurse practitioners, pharmacists, physician assistants, and community health workers. This allows them to practice “above the top of their license” and better coordinate care, ultimately improving outcomes. It also allows them to reduce costs by keeping patients out of the expensive hospital setting.