Value-based care is the future of healthcare in the U.S. These four core competencies can help guide your organization toward a model that improves patient outcomes while decreasing costs.
The healthcare industry is in the midst of a transformation—shifting away from a volume-based payment model toward a value-based care delivery model in which providers are compensated on patient health outcomes rather than incentivized to perform costly procedures and tests.
At the height of the COVID-19 pandemic, when providers had more patients than they had the capacity to treat, the shortcomings of a fee-for-service model were especially highlighted. Adopting policies that reduced high-cost, low-value care decisions became an urgent necessity. As a result, value-based care programs were fast-tracked to reduce costs and patient load. Based on lessons learned in making quick adjustments, mixed with best practices for value-based care, here are four core competencies healthcare facilities should use to guide their value-based care programs.
1. Leadership and Governance Help Strike Balance
Shifting to a value-based care model is a transformative process, especially for large healthcare systems and providers. Before implementing any changes, these organizations need strong leadership and a detailed plan to guide them.
Governance of value-based care initiatives should include stakeholders to represent all clinicians and healthcare facility staff. The right mix of leaders helps strike a balance between patient needs and provider workload.
Consider including leaders in medicine, nursing, health information and technology, and innovation in addition to the board of trustees. The process may also run more smoothly with input from patient experience leaders who understand how to make the process run smoothly for patients.
2. Patient Engagement Strategies Lead to Value-Based Care Success
Value-based care programs are most successful when healthcare providers use strategies that engage patients in their care. A foundation for patient engagement already exists in primary care.
Primary care providers have a unique opportunity to drive much of the patient engagement strategies that support value-based care. Patients who use primary care have better relationships with their care team, which helps reduce their risk for diseases through education and effective screening practices.
Appropriate screening and exams give doctors the opportunity to diagnose illnesses early, often in time to improve outcomes and reduce the need for invasive procedures and interventions. This prioritization of disease management also reduces both healthcare costs and emergency department visits.
Telehealth also has the power to engage patients who can’t find time or transportation to see a doctor. But telehealth is more than just virtual appointments. It’s also a tool patients can use to communicate with their providers, schedule appointments, view medical history and test results, and more. Used appropriately, this and other health technology can aid in value-based care programs.
3. Data Transformation Informs Decision-Making
In addition to telehealth capabilities, technology can contribute much more to value-based care initiatives. However, that’s often limited by the many different electronic health record programs on the market. Many of them are not interoperable, making it difficult for a patient’s care team to work together. Collecting data to track trends in patient care and unnecessary spending can also be cumbersome.
Organizations that pursue value-based care should prioritize data transformation to inform policies, implement changes and improve patient outcomes. Prioritizing interoperable health technology allows a patient’s care team to communicate and share patient records more easily, even if they work in different offices. It also gives primary care physicians, specialists and other clinicians the opportunity to collaborate without needing to scan records and make phone calls. It may also eliminate redundant tests and streamline care for patients, improving both patient experience and healthcare outcomes while reducing costs.
Health technology also collects data, tracks health outcomes, and monitors value-based care goals and other trends to inform decisions and illuminate issues with patient care. At the very least, it can help optimize workflows and reduce administrative burdens. At maximum efficiency, it can help identify additional low-value care concerns to address. However, much of this is possible only with buy-in from the physicians and clinicians who provide direct patient care.
4. Physician Alignment Is Key to Success
Physicians—especially those who practice primary care—bear a large share of the responsibility for many of the changes in value-based care transformations. Reducing high-cost, low-value care and promoting patient engagement largely falls on their shoulders, but they aren’t often incentivized to make care decisions based on value for both patients and the healthcare industry.
People who work in the healthcare industry increase revenue with low-value care, which increases costs for patients and the healthcare system as a whole. Essentially, they get paid for each test, scan, procedure, consultation and any other service they provide. However, unnecessary services like these account for much of the cost savings value-based care initiatives aim to reduce.
Getting physicians to align with value-based care may require changes in the way they work and how they’re compensated. Just half of physicians are aware of the cost of care, and less than half are comfortable broaching the subject with their patients. Furthermore, the percentage of physicians who receive meaningful performance bonuses of more than 5% has remained largely unchanged, according to Deloitte. Adopting value-based care requires physicians to become more familiar with the costs of care and tying it to their compensation. This may motivate physicians to make the shift to value-based care and drive the success of your care transformation goals.
The Future of Healthcare
Value-based care is the future of healthcare in the United States. The U.S. spends more money per person on healthcare than any other nation, and value-based care has the potential to change that. It’s becoming a priority for many healthcare entities and other stakeholders. Use these core competencies to guide your organization toward a value-based model of care that improves patient outcomes while decreasing costs.
About The Author: Medecision
Medecision® is a digital care management company whose solutions and services are used by leading health plans and care delivery organizations to support more than 42 million people nationwide. Aerial™, a HITRUST CSF®-certified, SaaS solution from Medecision, seamlessly connects the healthcare ecosystem to powerful data and insights that drive meaningful consumer engagement while creating efficiencies to reduce costs and support effective care, case and utilization management. Aveus, our professional services division, helps business leaders solve complex challenges and drive better performance, leaving organizations more capable.
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