For the many organizations shifting value-based models, here are five predictions for value-based care in 2014.
The transition from fee-for-service to value-based care is top of mind for many healthcare organizations as their leadership prepares for 2014. Value-based care, an umbrella term encompassing ideas including accountable care, population health and financial incentives for outcomes, will eventually be the norm for healthcare delivery and reimbursement. In 2014, however, many organizations will need to "straddle the fence" by preparing for value-based models while maintaining profitability in an environment that still largely pays based on volume of care.
For the many organizations shifting to these models, Lumeris, an accountable care innovation company, offers five predictions for value-based care in 2014.
1. Healthcare spending will increase if providers fail to manage high-risk patients and events. Because the just one percent of patients account for more than 20 percent of healthcare spending in the United States, care management programs will be critical to significantly reduce healthcare spending. According to Lumeris, "without Care Management programs that provide the technology, tools and workflows to support physicians, care managers, care coordinators and social workers in the stratification, engagement and management of high-risk patients and events, the industry will struggle to provide better quality care at a lower cost for people with multiple health and social needs."
2. EMR technology alone is insufficient for population health management. While electronic medical records are valuable in gathering data on quality and patient information, providers ned information at the patient and population level in a usable, readable format to fully realize the cost-saving and quality-improve potential of EMR technology.
3. Physician burnout will increase unless providers can get off the hamster wheel. A recent JAMA study found that nearly half physicians are experiencing symptoms of burnout, which may be exacerbated by the push to see more patients in a volume-based reimbursement world. Value-based care models, however, may alleviate burnout by allowing physicians to focus on patient care and outcomes, rather than volume of patient seen. Tom Doerr, MD, Lumeris' director of innovation research and a primary care physician, predicts that once physicians restructure their practices for value-based care and are given the incentives, tools and information to manage their patients and populations, they will find satisfaction in their work and avoid burnout.
4. Payers and their network of providers will assume greater risk under the Patient Protection and Affordable Care Act. Payers who are offering plans through the health insurance exchanges, as well as the providers contracted with these plans, face greater risk than when covering a more traditional population, because little information is available on enrollees and their health status.
"Managing risk in the marketplace requires a proactive and prospective approach," said Terri Bellmore, Lumeris' director of accountable care consulting services. "As health plans and providers assume risk for this population, they need to prospectively assess a patient's health status, and then properly document and code the conditions in order to manage risk and receive optimal reimbursement."
5. The impossible task of leveraging big data will be possible with interfacing. While big data analytics will be essential for managing population health, developing big data capabilities is a timely and expensive process that Lumeris estimates can cost health systems up to $100,000 a year.
To view the full Lumeris report, click here.