The transition to value-based care is putting costly acute care under a magnifying glass. Of the $3.8 trillion spent annually on healthcare in the U.S., an astonishing $1.9 trillion is dedicated to acute episodes of care, yet only $200 billion of acute care spend — or about 10 percent of it — goes to activities covered under value-based care agreements. This leaves a whopping level of expenditure going to expensive episodic care, typically provided at a hospital under a fee-for-service arrangement.
Yet, as payers increasingly prioritize partnerships with value-based care providers, hospitals and health systems are looking to align their business models with this priority.
During the Becker's Hospital Review 12th Annual Meeting, in a workshop sponsored by Sound Physicians, Robert Bessler, MD, founder and CEO of Sound Physicians, discussed five value-based principles health systems can adopt.
The five principles:
1. Align incentives and provider accountability for managing total episode cost. Because acuity of care depends largely on whether patients are considered high risk, low risk or no risk, it is good practice to assign performance-incentivized care teams to only one of those subsets. This results in more intensive, value-oriented workflows.
"When you get two to four of your 20 doctors to focus on a subset of patients, you can get better outcomes for those patients because you do the same thing every day the same way," Dr. Bessler said. "When you give doctors the time and resources, [it leads to] massive increase in advanced care planning, which leads to better patient experience and less futile care."
2. Support consistent practice with purpose-built clinical workflows enabled by technology. A purpose-built workflow is one that is triggered by a concerning observation about a patient and involves defining the goals of care for that patient, including advanced care planning.
Sound's technology platform, which layers on top of hospital EMRs, produces a prompt to help physicians determine whether they should activate a purpose-built workflow: Would you be surprised if this patient wasn't alive in a year? "If the doctor says 'No, I wouldn't be surprised,' that should trigger advanced care planning, because it's the number one predictor of mortality," Dr. Bessler said.
3. Focus on patients most at risk for adverse outcomes. Attending to patients who are members of a bundled payment, Medicare Advantage or accountable care organization program — that is, patients for whom an organization has taken on risk in a value-based agreement — and who are identified as high risk requires real-time data feeds and predictive analytics. Such focused management can reduce spend by more than $1,000 per episode, thereby reducing financial risk for the organization.
4. Ensure continuous physician oversight, real-time analytics and performance management. Putting meaningful data in the hands of physicians gives them visibility into those aspects of care they can control, such as deciding when to discharge a patient and how their performance affects value-based metrics, such as length of stay and readmissions rates. When benchmarked against regional averages, this data helps drive results, as in reducing the number of "failed" discharges (i.e., patients who are readmitted within a certain period) and avoiding penalties.
5. Enable high levels of collaboration with primary care providers, post-acute providers and plans. By fostering high-quality networks with senior nursing facilities and home health care agencies, and by putting doctors instead of case managers in charge of helping patients select a post-acute provider, organizations can reduce readmission rates attributable to poor post-acute care.
"We monetize by preventing readmissions, which is good for our hospital partners," Dr. Bessler said, explaining how Sound's platform supports organizations in overseeing patients' post-acute care. "We don't really care about an $80 billable visit ... what we care about is figuring out how [hospitals] get paid for the value of preventing a $13,000 readmission."