As physicians adjust to reimbursement reforms and work to promote patients' overall wellness, health systems should consider several key points to develop successful value-based care models, a physician wrote in a STAT op-ed.
Here are six lessons Andrew Snyder, MD, chief medical officer for Evolent Health, which partners with health systems to drive value-based care changes, learned while developing value-based care models:
1. Consider care quality for risk-adjusted patients. "The only question that should ultimately matter to primary care physicians is this: 'For how many risk-adjusted patients am I providing high-quality care?'" Dr. Snyder wrote.
2. Know the changing rules of a value-based care model. "Primary care physicians got really good at the volume game," Dr. Snyder wrote. "I am confident that when we all understand the new rules for creating value in healthcare, we will learn how to succeed there, too." And as health systems begin to save more dollars in value-based care models, some of those savings should be reserved for the primary care providers who helped generate them, Dr. Snyder said.
3. Sufficient risk-adjustment is an absolute. In a value-based model, data-informed risk stratification and risk adjustment that account for patients' social determinants of health and treatment across providers can help encourage physicians to reach for sicker and frailer patients by rewarding physicians for treating them, Dr. Snyder said.
4. Change practice operating models. Value-based care is about having more fluid communication and reminders for adherence to a practice's operating models, and new tools are needed to support these changing workflows, Dr. Snyder said. "That means we'll need to build new compensation models that reward the outcomes we all seek for our communities," Dr. Snyder wrote.
5. Weatherproof cracks in the system. Practices can prepare for problems in the value-based model by arming themselves with the tools to fix them, Dr. Snyder said. "Success in newer models requires clinical informatics as well as population- and patient-level analytics to maximize the efforts of everyone on the care team and ensure few-to-none fall through the cracks," he wrote.
6. Trust is the final frontier. Innovative reimbursement methods need a level of transparency insurers might not always share, Dr. Snyder said. "Transparency is a contractual must," he wrote. "I always say, out loud and often, that if primary care providers do not perceive absolute transparency into data and methods, then they shouldn't agree to a contract with the payer. Don't trust the negotiators, no matter how nice they are. Trust the numbers."