To reward health care providers for the quality of care they provide their patients, organizations are being encouraged to participate in new value-based programs such as CMS’ Quality Payment Program which has two tracks, the Merit-Based Incentive Payment System (MIPS), or Advanced Alternative Payment Models (APMs).
Additional value-based contracts with commercial payers are further accelerating the shift from fee-for-service to fee-for-value.
To be successful, the shift from volume to value has to be anchored in physician leadership that supports cultural change to create a more longitudinal alignment of values across the health care ecosystem while redefining the role of the patient.
When it comes to building their future-oriented strategy, there are three important areas of focus organizations should consider for transformation:
1. Culture, leadership and change management
2. Population health management
3. Patient safety and value focus
1. Culture, Leadership and Change Management
Physicians today face a significant paradigm shift. Even as they are increasingly relinquishing individual ownership of practices, they remain crucial in leading the transformation effort. And make no mistake: shifting from a fee-for-service culture to one that drives continuous quality improvement and better-coordinated care is a momentous one.
That’s because fee-for-service reimbursement has led to a reactive leadership model, where productivity is crisis-driven. In shifting to value-based care models, physicians are being asked to be team leaders, and take on more responsibility for planning and delegating across the health care continuum.
In addition to procedures and protocol-driven care, relationship-based approaches are needed to help energize and motivate staff and patients as they navigate new roles and behaviors. Emotional intelligence skills in engagement, activation and negotiation are essential to this new transition. Support, training and compensation alignment are key to transitioning risk-averse leaders into ones who embrace and lead change.
Advancement of educational programs for tomorrow’s physicians, nurses and additional care providers is also required to foster a more integrated, collaborative, team-based approach to care.
Aligning stakeholders across a complex and siloed health care system is a longitudinal effort. Strategic vision and planning has to drive interdependent relationships, processes and efforts across the health care ecosystem.
And while today we lack value-based and integrated measures, compensation models and skills that drive broader collaboration across providers, payers, patients and community agencies - focusing on simple quality and cost outcome measures - is a rudimentary first step.
New collaborative models within and across organizations are crucial to sustainable population-based care. Creating a holistic structure that drives interdependence across service silos is foundational to long-term population management. A structure that proactively addresses the unique needs of a patient through coordinated action and oversight that helps improve the quality of care can greatly reduce health care costs.
2. Population Health Management
As hospital executives continue to focus on technology implementations for population-based management, physicians are challenged to navigate complex reimbursement mazes as they prepare for the future of value.
Technology solutions fail to integrate effectively with practice-based workflows and rudimentary electronic health records (EHRs). Extraneous documentation requirements of new technologies fail to meaningfully engage providers and their teams as they continue to be burdened by administrative functions that take precious time from patient care. The complexity of meeting contract requirements of various payment models make integrated and quality care for patients challenging, leading to clinician and staff burnout.
Actionable information and data advancement continue to lag behind. There is still little investment in shared care plans where members of the care team - patients, providers and community agencies - have anytime access to relevant information for decision-making. Service lines still exist in and rely on four-wall care delivery, separate and distinct from one another with little interaction despite the proliferation of EHRs and other technologies.
Innovative delivery system leaders will rethink shared care sites where patients can receive primary care, specialty care, high-level outpatient management, urgent care and emergency care at the point-of-need, helping to divert patients from the highest cost services when they are not necessary. This requires careful transition management and preparation as organizations move away from reliance on high revenue capture of Emergency Room visits and hospitalizations to overall cost reduction of the system. It will also redefine relationships between delivery systems and patients to one of advocate and teacher rather than seller and marketer.
Our outdated four-wall thinking will be replaced with a new definition of what access to care means – moving away from arcane thinking like “third-next available” appointment. That means thinking beyond the traditional in-office visit as the means for physicians to treat patients and receive payment.
So if access is no longer an in-office visit, what is it?
For one, it’s digital care coordination - via secure email, text, social tools and electronic consults. It’s in-home care for the sickest patients and online video appointments for patients. Most of all, it’s a continuous, relationship-based care partnership between the patient and their medical team that provides access based on individual need.
3. Patient Safety and Value
Patient portals and email communication have minimally advanced patients’ ability to access some aspects of their care information. Meaningful and on-demand access to the teams, data and technologies to help them achieve better health outcomes is still evolving.
Shifting patients from passive members of the health care team to active members is a crucial transition. To be specific, rather than talking about and around patients, we need to shift to educating, engaging and activating patients as an essential member of their care team.
Because patients still have little understanding of their health – receiving little education in school, at their doctor’s office, or in their homes – education and prompts are an important first step. Understanding the role of the primary care provider and prevention are essential in ensuring that patients adhere to evidence-based care.
Patients, too, have been trained to be reactive with their health needs. They also need support to understand what their health plans cover and how to engage with the right providers and community agencies at the right time. They need to understand in their language what it means to make the care and lifestyle choices they do and how that translates to their personal health outcomes.
Redefining the role of patient to where they are seen as experts of themselves, and are committed and accountable members of the care team, requires a different level of partnership between the patient and the primary care provider. Decreasing the complexity of the system to single-point access and information sites is also crucial, as is giving patients access to understandable health information and data that supports and improves their decision-making.
Alignment of Values
Bottom line: Investment in people and relationships is what will create the value shift for successful health care delivery systems of the future. Bridging that gap will require approaches that extend beyond technology implementations and workflows. The longitudinal value shift will take patience, humility and hard work from the health care system and its patients.
Nicole Deaner is the director of practice transformation at CareAllies, a company that delivers the systems, capabilities and management services to help physician groups, hospitals, and delivery systems with their transition to value-based care.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.