Key Considerations in Healthcare Strategy when Transitioning to Value-Based Care 

Value-based care (VBC) is a holistic care approach and payment model, versus the fee-for-service model that largely still dominates the industry. VBC models have greatly increased in use and implementation and continue to become more widely used but it’s not an easy change for all healthcare organizations to make. Which leads to the question – 

What are the best strategies when transitioning to VBC? This blog will guide organizations towards strategies to consider when adapting VBC to ensure a successful transition.

Rethink Delivery of Care 

Transitioning to value-based care requires that healthcare system participants rethink how to deliver and compensate for healthcare. Delivery of care impacts patients and all healthcare providers involved in a patient’s circle of care. In current fee-for-service  models, healthcare is delivered and paid for by an individual patient’s visit or follow-up procedure. 

In VBC all of the services and visits necessary to treat the patient’s symptoms are bundled – and this extends across specialties to include all doctors, specialists, and nurses, as well as preventive and supportive therapies such as; doulas, counselors, and nutritionists. Delivery of care significantly shifts away from quantity to quality with VBC, with care centered around patient outcomes. Shifting to delivering quality care goes hand in hand with a holistic care approach. 

Defining “Holistic” Care

There are 2 facets to holistic care with a VBC model. One is the actual care continuum itself as we mentioned, where all services are combined. The other is the financial extension of that approach with a bundling method that combines costs for these services based on treatment outcome. In VBC models the incentive is on successful treatment and continued preventive care rather than step by step actions administered throughout the diagnosis.

Educate Healthcare Providers and Teams

Paving the path to success within an organization begins with education initiatives to accelerate the transition to VBC. The adjustment from fee-to-service to VBC can be a tedious adjustment for providers that have been practicing with the focus of quantity versus quality for years. Ensure that the entire healthcare organization is equipped to participate by educating them about the core tenets of value-based care, no matter how big or small of a role they will play.

Measuring Care Impact 

A new strategy that is needed in VBC models is to implement tools like real-time risk assessment and continuous patient evaluation through software and applications and platforms for two main reasons.

1. Hospitals and care facilities must be able to evaluate with up-to-date information from all involved care providers and practitioners within a patient’s treatment in order to coordinate care and create accurate and effective compensation practices. Patient data must be able to be updated and communicated within standard compliances, and communication channels must be maintained between both practitioners and patients. 
2. Providers must be thoughtful and clear. This requires a rethinking of how healthcare is delivered by providers but also all specialists the patient is going to see. It also requires that the communication between any provider and the patient is as seamless and accessible as possible. This means having a centralized method or platform that encompasses outreach, communication, provider connections, transportation logistics, and transactions across the full continuum of care.

There is no shortage of valuable data available to healthcare organizations and they must commit to quality improvements through reliable data. 

Why make the change

VBC causes healthcare leaders to rethink the processes and elements that have the greatest impact on a patient’s outcome. It also provides a clear format as to what is or is not a covered benefit for the patient. This approach leads to lower costs overall for facilities and providers through a few key shifts:

Risk analysis and shared responsibility

All providers and practitioners/departments work together to reduce collective spending. Risk is assessed and prioritization makes it easier to provide pertinent care.

Shared Savings

Financial load is shared among practitioners/providers so that saved funds in one department can be redirected to another to keep the collective on budget.

Bundling Cost

Bundling allows patients to have input on their care and opt out of services they don’t need. Patients don’t overpay, and providers can accrue savings from unused services.

Understanding the shared health needs of patients will make it easier to see how a VBC model can help you save on cost through bundling and shared savings across departments. With this information you can design your own unique solution to improving the quality of care for your patients. The analytics and data collected from Primavera’s Data Analytic platform to facilitate VBC success will make tracking health outcomes and patient data easy so you can justify and analyze cost and outcomes.

VBC creates great experiences and outcomes for patients, and generates higher bottom lines for providers. Though it is increasing in popularity, VBC is not dominating the entire market – but due to its flexibility and adaptive/integrative nature it is ideal for mitigating gaps in care that can be created by pay-per-service models. 

Patient-first care does not have to negatively impact revenue generation. At Primavera, we help you create the best strategies to implement VBC solutions into your practice. The goal is to close gaps in patient care and improve outcomes without incurring additional costs – and in fact, reducing them.

Through revenue optimization (driving down costs by improving efficiencies in coding and determining cost drivers), and identifying growth trends, we are able to help identify your specific benefits from switching to VBC. 

Reach out to us today to continue the conversation on how to position your healthcare organization to benefit from value-based care.