Value-based care means something different to patients, to providers and to payers. Understanding these differences and working closely with all these stakeholders is the key to successful adoption of value-based care.
In a December Becker's Hospital Review webinar sponsored by Altera Digital Health, Jeanne Armstrong, MD, chief medical officer, and Ben Scharfe, executive vice president, both of Altera Digital Health, discussed the importance of understanding value-based care from different stakeholder perspectives and the necessity of facilitating change through organizational improvements and patient and provider engagement initiatives.
Five key takeaways were:
- Understanding the definition of value-based care for each stakeholder as well as the different risk models is critical. "Value-based care is a broad topic, and it means different things to different people," Scharfe said. "For patients, value means health, mobility, mental clarity, life expectancy, pain reduction and reducing the financial burden of healthcare costs. For payers, value is measured primarily through cost savings and as a direct financial incentive for providers. Often, this translates to getting rewarded for work providers are already doing."
The CMS Innovation Group Risk Spectrum defines three main value-based care payment models:
- Upside models reward providers based on quality metrics.
- Downside risk models set a budget for each patient based on risk.
- The capitation model sets a budget for a pool of patients based on risk.
"These models financially incentivize primary care providers to leverage cost-effective preventative care of all forms," Scharfe said.
- Making operational preparations can help overcome challenges of value-based care implementation. "Most primary care practices are unable to be fully capitated because they have patients with different insurance payers," Scharfe said. "This potentially translates to providers juggling multiple workflows for different patients or following a single workflow that is optimal for only one model." Scharfe also highlighted that “with upside risk there may be a delay before seeing financial results” and “the clinical results of preventative care can also be less tangible.”
Operational changes that can alleviate these issues include maintaining capital reserves, coordinating the care team, using data analytics, focusing on patient engagement and having leadership buy-in. "Most physicians want to be able to provide these services, but it requires the entire organization to think differently," Dr. Armstrong said. "The provider is now the leader of a complex care team, which is a big change in thinking and then in documentation. You need a systematic approach; learn from tools and tips, articles, patients teaching patients and other strategies."
- Increase provider engagement by aligning compensation and increasing data transparency. "Some systems hold back some provider compensation for payout at the end of the year, with an adjustment based on quality scores," Scharfe explained. "Since there's not much financial implication until the end of the year, perform regular quality reporting throughout the year to encourage competition and share best practices. It can be compelling to show providers their actual data."
- Recruiting patients onto their own care team and empowering them to take an active role is key. "Engaging patients and influencing their behaviors is at the heart of value-based care,” Scharfe said. "The vast majority of what influences the health and outcomes of patients is their own behavior. So, naturally, for practices to be successful, they must find new ways to engage patients. This is where technology can help."
There's a shift from patient portals to personal health records that patients can review, control and correct. Providers can drive adoption by providing tools and education to help them interpret that data. "For example, that might be something as simple as sending an alert if patient health numbers stray outside of target levels," he said. "Education and ease of use are really important because these are closer to consumer technologies."
- In the future, CMS will continue updating guidelines, social determinants of health will be even more important and the downward pressure on fee-for-service will grow and new models will arise. "For care organizations, these shifts represent opportunities to create value by driving down healthcare costs and reducing waste," Scharfe said. "There are significant financial rewards for care organizations that generate savings through creating value."
By understanding value-based care from the perspectives of each stakeholder group, health systems can encourage adoption through organization change as well as through provider and patient engagement.
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