Value-based care (VBC) is an alternative to the historical fee-for-service (FFS) model of healthcare reimbursement. It means transforming the payment model such that the healthcare provider – the physician, for example – is paid not necessarily by volume and the types of procedures, but is compensated for the quality of care – a more coordinated and appropriate approach.
VBC affords many opportunities for improving the quality and continuity of care for healthcare organizations and their patients. Transitioning to it can be a challenging and involved process, so let’s look at why this model is worth your consideration.
Reduce out-of-pocket spending with higher quality deliverables
Out-of-pocket payments (OOP) are highly influential financial elements across the health sector – particularly in lower-economic populations where financially vulnerable patients are significantly affected by OOP costs.
Decreasing OOP costs seems like a no-brainer for improving patient retention and increasing access to care – so the issue boils down to does reducing OOP compromise care quality? The short answer is it doesn’t have to.
VBC models promote higher-quality care deliverables for reduced OOP models by increasing patient monitoring (through easy access to resources, education, and communication), increasing simplicity for revenue optimization and collection, and resource management through risk assessment and data analytics.
Improve coordination between physician behavior and incentives
From changes in clinical and organizational workflows to the underlying data infrastructure of practices, it can be challenging to coordinate an effective relationship between physician behavior and offered incentives. In the VBC model this relationship can reflect greatly in both preventive and post care follow ups.
“VBC helps to promote care delivery transformation” by facilitating a redesign in approach for primary care efforts – a lot of which is supported by newer technologies, apps, and cloud-based solutions.
Physician payment incentives for value remain small relative to total compensation, with continued emphasis on productivity. Challenges cited include the lack of a single enterprise wide electronic health records platform for information exchange, limited ability to influence specialists who were not exclusive to the organization, lack of payer cost and utilization data to manage costs.”
The success of incentive programs depends more and more on the communication success between patient data and the ease of that data’s implementation across the organization. Features like real-time risk assessment, one-touch communication, and transaction capabilities make continuous care models not only sustainable, but achievable.
Drive customer retention
Health is a well-intentioned business, and the number one way to boost business is to create more affordable, higher-value products. In this desire, patients are no different than any other consumer – they want the best care value for their money and in return you will drive retention and an expanding client base.
While retention is largely cost-based, in VBC models it depends on all factors, let’s break down the implementation.
A Primavera advisor can help you transition to value-based care and improve the quality, value and care for your patients.
Step one is to evaluate the best ways for your practice to engage in VBC contracting and care initiatives. This leads us first to revenue optimization.
We mentioned offering higher quality products for a better value. This begins with lowering medical costs by first improving your infrastructure efficiencies and determining cost drivers such as MRA and MLR.
Next we want to improve healthcare results by closing gaps in care tracking and collecting data more efficiently to help identify outliers, diagnose trends, and mitigate risk while simultaneously improving patient outcomes through more efficient communication and care plan execution.
Finally, we want to use data analytics to identify positive growth trends within your patient-base to help expand on successful programs, and improve the patient panel experience and care delivery systems; consultation, transportation, payor services, vendor relationships, etc.
VBC all ties back to retention as it is a client-first solution – but one which doesn’t exclude the needs and values of the organization. Is it a newer and less widespread model than traditional care systems? Yes. But that makes sense since it has evolved with brighter technologies that can make it not only an appealing, but an extremely practical solution.
Our software solutions enable you to improve the quality of care and enhance the patient experience while helping you take control of your financial future through VBC models and overall streamlining of your organization.
Transitioning to value-based care is challenging; requiring resources, time, a priority shift, and evaluation but with a Primavera advisor – it’s easier together. Let us map out the plan and tools you will need to be successful.
Primavera customizes value-based care solutions based on your needs, to drive better clinical and financial outcomes. Providing revenue optimization and improved medical economics. Our experience and expertise in value-based care strategy and implementation allows you to focus on ensuring patients get the right care – with quality health outcomes.
Reach out to us today to learn how we directly support you to continually improve outcomes across your organization by encouraging collaborative models like value-based care.