In the rapidly changing healthcare landscape, providers must shift from volume-based care (fee for service) to a value-based reimbursement structure (fee for value). This shift toward value-based reimbursement is built around the goals of developing coordinated care, becoming more patient centered and achieving positive health outcomes.
A value-based approach is designed around patients. Medical care teams zero in on individual needs, whether preventive, chronic or acute. Individuals benefit from a team that coordinates care and technology that connects patients and providers with information to help get the right care across the health care system. Many physicians are asking how to begin the transition. Outlined below are some of the basic components required to transition to value based care.
Value based care calls for a significant increase in the need to acquire, aggregate, and analyze data across a provider community. The data base system must be one that can collect data and have the interoperability to share with other providers. The focus is how to identify the collective issues, risks and opportunities associated with the patient. The challenge is in creating a single view of a patient so that all providers have the same perspective. The data management solution has to be able to gather data from disparate systems and different organizations.
UNIFIED CARE PLAN
A care plan is a means of organizing a patient’s needs and identifying the specific steps to achieve an agreed upon outcome. Once a patient has a comprehensive care team of providers (primary care physician, specialist, or therapist) focused on all of their risk areas, each provider can contribute to a unified plan. Value based care requires that the data is gathered so there is a shared perspective among a number of providers and the patient care team.
Care coordination is managing the flow of information of providers with different systems. This is an important goal because providers are being measured on the outcomes of the patient respective of the provider’s participation. The challenge is how to help providers share the information in a single view and to communicate with other providers or each other.
A patient’s engagement in their own healthcare is an important contribution to improved health outcomes. Patient engagement tools are helpful and applications such as reminders for medication or follow up visits are effective ways to interact with a patient when not in the office. Staff members like patient navigators or peer coordinators can facilitate interactions and can be helpful with non-face-to-face communication.
Equally important, is the ability to get the information (data) back from the patient. Once the patient leaves the office, providers often have no idea if the patient is following the plan. Therefore, using technology such as Surescripts “Med Adherence” to collect drug history when not face to face is a very important aspect of engagement in assisting with the goal of achieving positive health outcomes.
PROGRAMS AND OPPORTUNITIES
New initiatives are emerging with the goal to incentivize the move towards value-based care. One reimbursement program, Chronic Care Management (CCM) is a new way for practices to jump start their value-based care plans. A successful CCM program provides additional benefits to the patient and providers including better quality of care, higher patient and provider satisfaction, and lower costs. CCM has the potential to realize new revenues without seeing new patients. It is an opportunity to be reimbursed for the non-face-to-face care already provided to patients in the practice.
There are other value-based programs such as Accountable Care Organizations (ACO), Patient Center Medical Homes (PCMH), and Pay for Performance (P4P). Accountable Care Organizations are transforming care delivery by paying health systems and doctors based on their success at improving overall quality, cost and patient satisfaction with their health care experience. A PCMH is a care model led by a primary care doctor that is focused on providing enhanced care coordination across the health care system. When practices do well on quality and efficiency measures, they share in the savings they create. The P4P model rewards doctors and hospitals that improve or maintain quality, while keeping across-the-board rate increases lower. If the doctor or hospital meets or exceeds the performance measures, they receive payment that had been put aside as an incentive for improved care. While still fee-for-service, this entry-level value-based model encourages quality and efficiency.
The transition to value-based care encourages healthcare providers to deliver the best care at the lowest cost. There are many ways and tools to help a provider bridge the transition to value-based care. By identifying the right technology, collecting the necessary amount of data, using the information to coordinate flow between providers and engaging patients to be more responsible in their own care, patients will receive a higher quality of care, with improved outcomes at a better value.