As provider organizations make the transformation to value-based care (VBC) payment and delivery models, the potential for missteps can strike fear into the hearts of stakeholders throughout the organization. What if these initiatives fail? What if you can’t deliver the same type of care to the same patients as you have in the past? What if margins narrow to the point of unsustainability?
While these questions can certainly be cause for concern, the benefits VBC can deliver can outweigh the risks. Whether in the first steps of a VBC transition or looking for ways to further capitalize on VBC success, we have identified the top 10 strategies to succeed within VBC delivery and reporting:
1. Robust investments in analytics. One of the most valuable aspects of VBC is its ability to force providers to address the fundamental problems resulting in poor quality in patient access and outcomes. This only happens through clean data effectively analyzed. Understanding the patterns in your data allows you to act on trends before they become cost-draining issues. The cost of investing in a population health management solution can help to generate higher savings in the long run.
2. The importance of patient engagement. Strategies that personalize delivery to patients’ needs and preferences are the most likely to succeed. Look to cultivate true provider-patient relationships through strategic patient engagement. Making patients more active participants in their care has been shown to improve clinical outcomes, increase patient satisfaction scores and improve service delivery. Effectively managing patients with chronic diseases, facilitating care transactions and reducing hospital readmissions all depend on the deployment of sophisticated patient engagement and care management strategies.
3. The importance of data quality. VBC values quality outcomes, not the number of tests you perform or how many patients you can see in an hour. The only way to report on those outcomes—and get paid for the service you provide—is through quality data. Look to health IT solutions and data registries that help provide the level of clean data you require.
4. Enhanced care coordination. The most successful VBC models are those that freely share information to ensure care coordination and strengthen communication among all organizational participants. Sharing cost and quality information between providers and payers is foundational to the success of any VBC program.
5. Management of upside and downside risk. Managing upside or downside risk effectively is a key driver for VBC success. Successful VBC veterans have some experience with risk contracting. This experience is immeasurably valuable, given how interwoven VBC and effective population health management are. As insurers reduce prices for risk-based plans, they will become more attractive to employers, consumers and other purchasers. Physicians who want to continue fee-for-service models will find themselves with fewer payment options available.
6. Levels of incentives. When implementing as major of a process and workflow change as VBC requires, rewarding both achievement and improvement can help to move the needle closer to success quickly. Base incentive rewards on well-defined targets, defined prior to the start of the measurement cycle in clear, absolute terms. The goal should be to improve overall care quality and to create personalized experiences for every patient—and rewarding the physicians who most effectively make that happen.
7. Aligned management. VBC leaders need to be more than managers. They have to be absolute champions of VBC, and ensure a unity of messaging and expectations in all their communications. As we said in our recent white paper on effective ACO practices, “Leadership has to set the model that drives effective behavior among all partners at all levels. Passion, engagement and clear communication are the hallmarks of effective leadership— the characteristics of a leader who can engage a group of physicians and encourage them to behave in a way that makes them successful.”
8. Resource utilization . One of healthcare’s biggest legacy issues is how best to use resources. Traditionally, healthcare tries to solve issues by adding more staff. Successful VBC practices recognize that this isn’t a solution at all. Instead, they look to ensure that every member of the staff is operating at the top of their license. This increases operational efficiency and helps to manage overhead costs.
9. The value of integration. Integration is the focus of successful healthcare leaders. Effectively integrating patient and provider data drives clinical transformation and strong financial management. Value integration must encompass strategic and tactical responsibilities for healthcare providers. Part of this manifests as a team-based patient care coordination approach, eschewing the traditional patient-provider relationship to empowering the patient as an active participant in their own care management.
10. Prevention-oriented population health practices. In VBC, there is greater financial reward in preventing illness than there is in treating disease. Reducing expenditures can be accomplished by identifying preventable hospitalizations and preventable readmissions. This idea was recently put to the test in the Pioneer ACO program, which scored high for preventative health care measures, generating $147 million in total savings for these initiatives.
VBC care models are still in the early stages of development. While there are sure to be challenges in the months and years to come, the success that VBC promises is sure to deliver better care to patients and reduce spending. Look to these top 10 characteristics of VBC success to help achieve delivery, outcomes and reimbursement goals.