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

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. 

Rolian RuizKey Considerations in Healthcare Strategy when Transitioning to Value-Based Care 
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Increasing Profits Through Value-Based Care

Hospitals and health systems are looking to optimize their revenue by turning to value-based care from volume-based care. Widely used models where the number of patients determines the financial success of the practice is now being offset with the option to profit off preventive care and increase the quality of care.

So how does this work? And what are the benefits to patients, and to the healthcare facility and its different departments?

Incentive & Bonus Payments

VBC programs award practitioners based on the quality of care they are providing through bonuses and incentive programs. As an example, with the center for Medicaid and Medicare services, there are 5 key VBC rewards programs:

  • End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
  • Hospital Value-Based Purchasing (VBP) Program
  • Hospital Readmission Reduction Program (HRRP)
  • Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
  • Hospital Acquired Conditions (HAC) Reduction Program

Incentive programs like these are meant to motivate care optimization and help the healthcare industry as a whole move away from fee-for-service models and into bundled care solutions that are compensated by overall patient health.

The drive for this performance-based shift has been evolving since the passing of the 2010 Affordable Care Act (ACA). In 2018, this alternative payment model (APM) comprised roughly 36% of total U.S. healthcare payments up from 25% in 2015.

To work, bonuses and incentives can’t stay stagnant and they have to grow proportionate to APM revenues, and live in a 10-20% range of projected cash compensations.

Stabilized Cash Flows

Perhaps the most attractive benefit of VBC is that there are more predictable cash flows in times of service fluctuation (e.g., the coronavirus pandemic). Financial losses were top of mind during the height of the pandemic as hospitalizations increased exponentially, affecting providers in unexpected ways, and testing their ability to adapt. Those practices able to embrace digital telehealth solutions were able to stay more nimble without compromising their data collection and intake processes, further – those with VBC models were able to continue to receive regular payments vs fee-for-services models which saw a staunch decline. 

“Hospitals and health systems that have mostly recovered from the initial hit of the pandemic had invested before the crisis in areas such as hospital-at-home services and digital capabilities that allowed rapid expansion into virtual care and remote patient management.” 

Additionally, certain healthcare practices may actual thrive under a virtual care model:

Some specialties, such as mental health, may find stronger footing via virtual visits. Healthcare provider executives surveyed by HRI most frequently cited mental health and psychiatry (58%), family medicine (56%), obstetrics and gynecology (46%) and pediatrics (44%) as the specialties in which their organizations will offer virtual visits in 2021.

Payers may wrestle with how to reimburse and, in some cases, provide virtual care. Pharmaceutical and life sciences companies may have to determine where they can and should plug in, literally. Providers may continue to improve the patient experience and be careful not to create new disparities in the health system through lack of technology access.

With 95% of large US employers covering telehealth, up from 56% in 2016, business leaders will have a say in how virtual care is used and how it should be woven into the healthcare system.

The revenue (and analytics) of VBC models stabilizes revenue and spending by improving patient outcomes and creating more consistent care continuums – identifying gaps in care, and bundling treatment modalities for preventive care options.

Healthy patient populations create revenue as new reimbursement policies put forth by payers and government agencies promote preventive solutions.

Go Beyond Hospital Walls

A big proponent of the success of VBC is that it is adaptable and, because it is focused on treatment success over fee-for-service, this model is able to be more flexible in incorporating external therapies within approved networks. 

With greater accessibility comes the need for greater amounts of data to manage it and along with the implementation of VBC comes the need for real-time applications and management platforms to capture and analyze patient data; for reporting but also to mitigate risk. 

When it comes to utilizing these applications; for patients it needs to be incredibly easy to use – accessible with the tap of a screen, and for providers it needs to be able to track multiple practitioners, patient records, manage transportation, and facilitate transactions, all with regulation levels of security and compliance.

At Primavera, we focus on real time results and make it easy to access the complete member record, case management, scheduling, transportation, healthcare analytic care data and financial analytic data for your patients and practice. This integrated support is what gives VBC models the organization and adaptive structure they need to support a variety of patients – even under unexpected circumstances – without compromising profitability.

Curious how this solution could work for you? Reach out to us today to get started. 

Rolian RuizIncreasing Profits Through Value-Based Care
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Primavera Webinar: Excelling in the Business of Value-Based Care

Primavera Presents: Excelling in the Business of Value-Based Care

  • Are you looking to learn more about how to adopt and embrace Value-Based Care?
  • Is your organization lacking a Value-Based Care strategy and implementation?
  • Are you hoping to improve patient care while reducing costs but don’t know where to start.

If you answered “Yes” to any of those questions, this webinar is for you.

Watch the webinar below to learn great insights and solutions on how you can not only engage in Value-Based care but benefit with the help of our expert advisors:

  • Value-Based Care fundamentals – what it might mean to different people at a practice
  • Important key drivers necessary in VBC that help align, patients, payers and providers in a value-based structure
  • Risk payer settings and how to best position your practice in an advanced payment model
  • How important technology and administrative infrastructure is in setting your practice up for success
  • I think VBC is right for me – What steps can/should I take?

Rolian RuizPrimavera Webinar: Excelling in the Business of Value-Based Care
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3 Benefits of Primavera’s Value-Based Care Advisory Services

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.

Getting Started

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.

  1. 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. 

  1. Improving Results

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. 

  1. Membership

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.

Solution Enablement

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.

Rolian Ruiz3 Benefits of Primavera’s Value-Based Care Advisory Services
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Primavera Webinar: Position Yourself to Benefit from Value-Based Care Through Data Analytics

With the shift in healthcare to value-based care, has come with an increase in data and increase of expectations for healthcare providers. Learn how to leverage your payors data to position your practice and patients to benefit from value-based care through this recorded Primavera webinar.

This Primavera Webinar: Position Yourself to Benefit from Value-Based Care Through Data Analytics provides some great insights on:

  • HealthCare’s Industry shift from Fee-For-Service to Value-Based Care
  • How to leverage your payers data to position your practice and patients to benefit from Value-Based Care
  • Identify patients in need of intervention to improve outcomes
  • Determine opportunities for improvement for cost reduction and revenue generation
  • Primavera Data Analytics App Functionality

 

Rolian RuizPrimavera Webinar: Position Yourself to Benefit from Value-Based Care Through Data Analytics
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