Value-Based Care: The Case for a Phased Transition

June 11, 2020 For Dentists, For Doctors

Value-based care marks a major shift in healthcare provision. In recent years it has experienced a surge, growing from 10.9% to 53% of services provided between 2012 and 2017. Those figures are only set to increase – and they will, so long as healthcare providers take a measured, phased approach in transitioning to value-based care.

What is Value-based Care?

Value-based care is a quality over quantity approach to medicine that aims to improve the overall experience patients have when they interact with the healthcare system, while also reducing costs. It differs from fee-for-service in that providers are reimbursed based on outcomes instead of services rendered. This gives providers the incentive to focus on preventive care and whole-body wellness, rather than simply providing care when a patient is already sick.

Under a value-based care system, providers partner with commercial insurers, Medicare or Medicaid, and are paid based on their ability to meet certain performance benchmarks. Most of these benchmarks are tied to long-term health outcomes of patients i.e. vaccines, screenings, and disease management.

The Challenges of Implementing Value-Based Care

While the shift to value-based care has grown dramatically in the past decade, fee-for-service payments still account for some 39% of healthcare payments. Another quarter combines fee-for-service with either quality or value metrics attached. The reason for this is that one of the biggest benefits of value-based care is also one of its biggest challenges.

Under the system, providers shoulder expanded care management responsibilities, positioning them to treat the “whole” patient. This requires proactive treatment and care, as well as educating patients on how to manage and monitor their own health. Patient outreach and engagement, therefore, become a large part of the approach. Providers will need to gain insight into the patient’s entire medical profile, which requires extensive data management, cost reporting, and collaboration with other providers. Keeping an eye on broader community health trends is also vital.

Obviously, this all requires a major shift in how a provider operates. But there is a solution that minimizes financial risk and maximizes outcomes: phased implementation.

Bit by Bit: Incorporating Value-based Care

Research from healthcare data company Geneia suggests a phased approach that minimizes upfront risk while showing upside as quickly as possible. The exact approach will vary depending on the specific needs of the provider, but strives to address key needs, deliver early ROI, gain internal support, and encourage further expansion.

For a small clinical provider, the first phase will typically involve implementing reporting or data analytics. This enables providers to gain insight into care gaps and measure program effectiveness. The second phase involves community engagement and care management. This allows providers to initiate care transitions, reduce unnecessary emergency services provision, and monitor models and performance. The third phase involves evaluation and expansion of services, helping to reduce barriers of care, and improving the management of chronic conditions.

This step by step implementation approach helps providers maintain revenue as they shift to a value-based model, while also facilitating improved management of readmissions. This enables the provider to move from reactive healthcare to proactive healthcare.

Value-Based Care is What’s Next

Value-based care is the future of healthcare. With pioneer organizations taking the first steps, many other providers have an example to follow. By choosing a gradual implementation that focuses on costs and effectiveness, then engagement and outreach, and finally expansion and collaboration, providers can transition to a value-based care approach in a way that is both low on risk and high on ROI.