Negotiating the Shift to Value-based Care

Value based careOur rapidly changing healthcare environment has, among other things, prompted a seismic shift in how providers care for their patients, precipitating the move to a new value-based reimbursement model. The traditional fee-for-service structure promotes quantity over quality, paying providers for the amount of services performed. By contrast, value-based reimbursement aims to provide better care for individuals as it reduces costs, compelling providers to use evidence-based medicine, engage patients, upgrade office technology, and more.

Obviously, this shift is a boon for patients. Provider teams zero in on the individual’s needs, whether they’re preventive, chronic or acute. The patient, meanwhile, receives technologically enhanced, coordinated care across the entire healthcare system.

As a physician, how do you to begin the transition to value-based care?

Here are the five basic components to get you headed in the right direction.

  1. Data management. Value-based care calls for a significant increase in the need to acquire, aggregate and analyze data across the provider community. To do your part, your system must be able to collect crucial information and share it with other providers. The goal is to identify the issues, risks and opportunities associated with each patient. The challenge is to create a unified patient profile using data gathered from disparate systems and organizations.
  2. A unified approach. With the value-based approach, the data gathered is shared among providers and the patient care team. Once a patient has a comprehensive group of providers (primary care physician, specialist, therapist, etc.) focused on every risk area, each can contribute to a unified plan.
  3. Care coordination. Because providers are measured on the outcome of each patient, managing the flow of information between different systems is key. The challenge is how to facilitate communication and the sharing of information.
  4. Patient engagement. Outside the office, apps and other tools can be an effective way to remind patients about medication, follow-up visits and other issues. On-staff patient navigators or peer coordinators can also facilitate interaction. Equally important is the ability to get information from patients once they leave the office. Technology like Surescripts’ Med Adherence, which collects drug histories, can be invaluable to patient engagement and achieving positive health outcomes.
  5. Programs and opportunities. New initiatives have emerged to incentivize the move toward value-based care. The Chronic Care Management (CCM) reimbursement program can improve the quality of care, increase patient and provider satisfaction, and lower costs. It also has the potential to generate new revenue for care that’s already been provided at some level. Accountable Care Organizations (ACO) are transforming care delivery by paying health systems and doctors based on their success with improving overall quality, cost and patient satisfaction. Led by a primary-care physician, Patient Center Medical Homes (PCMH) is focused on providing enhanced care coordination across the healthcare system. The Pay for Performance (P4P) model rewards doctors and hospitals as an incentive for maintaining and/or improving the quality of service while keeping across-the-board rate increases lower.

Value-based care is still a fresh concept for providers, and many are still working to incorporate the above components into their day-to-day workflow. But as new programs and tools emerge, physicians will continue to see reduced spending for their practices, improved quality of care for their patients, and other tangible benefits.

Now is the time for you to begin reaping those benefits. Contact AssuranceMD today.