Care Management:
A Critical Focus in Successful
Value-based Care

Trends in healthcare management

Slowly but surely, health care is headed in a new direction – value-based care, in one form or another, is becoming the new norm. However, if you asked health care providers how their day-to-day activities have changed since the start of this transition, most would say they feel stuck between the somewhat conflicting legacy models operating on a fee-for-service premise and the new world of value-based care.

From a care management perspective, executives looking to move to an Accountable Care Organization (ACO) face increasingly complex challenges. Rather than being paid by the treatment, health care providers are paid for having healthy patients. Through experimentation and the right vision, executives can find success operating in this complicated system.

Value-based care requires a new mindset – we must think about people not as patients but as individuals who occasionally need treatment and more frequently need assistance with staying healthy and preventing disease."

Our Approach

Here are a few key care management strategies to keep in mind during the transition to value-based care:

Be More Experimental

When taking on any sort of risk, executives should think more experimentally. This is not an easy change as the health care industry has been mostly risk adverse in the past, but represents an important shift in the way we think about delivering care to patients. Learning how to predict and plan for costs that are avoidable, such as readmissions and Emergency Department visits, is a process that is proactive in nature and requires some level of trial and error to achieve the best outcome.

Engage Everyone

Retaining your health care members goes beyond physician engagement. Increasing or augmenting your services portfolio can add to the overall value proposition of your organization. A design thinking or co-create methodology is a collaborative and iterative process to identify issues, prioritize initiatives, and develop strategies to address such challenges. It is through such efforts that providers will better understand the patient and family needs to mitigate patient leakage, reduce readmissions, and ultimately improve population health outcomes.

Think Long-Term

Whether investing in data analytics to understand your patient population or to equip high-acuity health staff with information to more effectively manage and transition patient care, it is important to build a solid foundation for long-term ROI. Providers need to approach this like a startup, understanding that success hinges on getting the core components in place upfront and growing as quickly as possible once the key processes have been sorted out.

Transitioning to value-based care means providers need to leave the past in the past and become more comfortable with the new ways of delivering care and new ways of operating. Recent polls have shown that healthcare leaders generally agree with the premise of value-based care as they begin to see the improvements in the effectiveness of care management and the overall efficiency of new care models. They need to be more experimental and engage everyone as well as think long-term and invest accordingly. It is here where healthcare providers can be more successful in moving towards a model for long-term success.

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