Value-based care models are gaining popularity across the country because they provide a way to incentivize providers to deliver healthcare most efficiently. They also help patients manage chronic conditions more easily and avoid costly tests, medical visits, and medications.
To make the transition to a value-based model work, practices must follow certain best practices. These include working with payers, focusing on quality, building a team, and engaging patients.
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Collaborate with Payers
A value based care model aligns with the goals of patients, providers, health plans, employers, and government organizations. It provides a clear path to delivering better care at lower costs and improving the quality of patient outcomes.
While fee-for-service (FFS) models have dominated healthcare for decades, the current landscape is changing. A growing number of public and private payers are adopting alternative payment models that reward providers based on their health outcomes or cost management performance.
The best way to prepare for this shift is to implement health IT systems that can gather, analyze and report data from across the organization. This will help providers assess and improve their capabilities for a value-based model.
A good place to start is with high-risk, high-usage individuals who drive high medical costs. These patients are often poly-persistent, which means they have multiple chronic conditions and co-morbidities that affect their overall wellness.
They also have a high rate of emergency department use, which drives up hospitalization and other high-cost services. These populations may be the perfect candidates to test a value-based model.
With a solid foundation, a provider can collaborate with its health plan to design the most effective value-based care model. This will involve a shared vision and strategy, the pace of transformation, coordinated care processes, expansive data sharing, targeted outcomes, and aligned incentives.
Focus on Quality
A value-based care model aims to improve patient health outcomes and reduce healthcare costs by aligning the needs of patients with their providers. In other words, the goal is to provide care patients need and are willing to pay for at a price they can afford. This approach is driven by some factors, including the patient’s ability to manage their health and a variety of other metrics.
The most effective value-based care models combine data analysis, quality improvement, and a comprehensive patient experience. These efforts help improve patients’ outcomes and reduce costs while providing physicians with a sustainable revenue stream.
Unlike fee-for-service (FFS) models, value-based models focus on improving quality rather than delivering volume. This approach allows clinicians to focus on what matters most for patients and can lead to more individualized care, reduced hospitalizations, and fewer emergency room visits.
A team should consist of the clinical, business office, and IT staff responsible for monitoring KPIs and developing visual plans to improve progress. By doing so, they can highlight points where process changes need to be made and maximize actionable insight.
While some critics argue that value-based models are just another form of industrial health care, it’s important to understand that the model focuses on reducing healthcare costs while improving patient health outcomes. It’s an approach that connects clinicians to their purpose as healers and demonstrates that they can meet patients’ needs.
Build a Team
Adopting a value-based care model requires a team, and it takes time to build a comprehensive program. Organizations must understand their unique role in the health system, determine a strategic path for improvement and implement that plan.
Value-based care (VBC) program aims to deliver high-value care while reducing costs. It’s a goal that everyone in the healthcare ecosystem can benefit from.
The key is to focus on patient outcomes, a metric that is important not only to patients but also to providers and insurers. A VBC model must be designed with the right payment and incentive structures.
Bundled payments can be the most effective payment approach for delivering high-value care. These payments typically cover the full care cycle for acute medical conditions, chronic conditions for some time, or primary and preventive care for a defined population (such as healthy children).
By focusing on quality, patient satisfaction, and adherence to treatment plans, providers, payers, and suppliers can benefit from the transformation.
The transition to a value-based care model is an ongoing process that involves building a culture of continuous improvement and learning from experience. Educating doctors and nurses about the core principles of value-based care is a good way to start.
Involve Patients
While value-based care models have many benefits for patients and providers, there are certain steps that healthcare organizations must take to ensure their success. These steps include getting buy-in, developing a team, and following the right process.
Adopting a value-based care model is a major shift for healthcare organizations. It requires them to get buy-in from every relevant stakeholder, including physicians, physician assistants, nurse practitioners and nurses, leaders, and clinical staff.
It also involves designing a new workflow to help the organization deliver better care and meet patient goals. This can require a significant change in how services are delivered, especially regarding care coordination and data capture and analytics.
Involving patients in transition to a value-based care model is critical to their health and happiness. This includes letting them know what is expected of them, how the new model will impact their care, and the rewards for achieving goals.
As the United States approaches an aging age and escalates healthcare costs, it is crucial to adopt a value-based care model that can reduce those costs and provide the highest quality of service for the patient. While the United States is currently lagging behind other nations in performance and access, a value-based care model could help it move up the rankings and become a world leader in health care.
