The U.S. healthcare system is immersed in the most significant payment reform changes in decades.
This transition from rewarding the volume of care to the value of care – measured by patient outcomes – brings substantial challenges and opportunities to all stakeholders in the industry. And it holds even more importance for an emerging healthcare hub such as Arizona, a state in which healthcare job growth and overall job growth has outpaced the national average.
Before we understand where healthcare reimbursement is going, we need a quick assessment of where it is, and that’s the long-established fee-for-service model. Under this model, healthcare providers are compensated for each service they deliver, like office visits or tests. There is no financial reward for improving overall health outcomes or practicing cost-effective, quality care.
The transition to rewarding value instead of volume will place a high priority on keeping patients healthy and away from high-cost centers of care. Whatever the financial arrangements and whether they’re called “value-based,” “risk-based” or “outcomes-based,” these payment models hold one key common attribute: they shift risk from payers to healthcare providers. This understandably makes doctors nervous.
However, by aligning their medical practices with the following four core principles of value-based care, and striving for collaboration among healthcare stakeholders throughout the care continuum, healthcare providers can set themselves on the course towards cost-reduction and improved patient outcomes.
Community care coordination: Optimizing value-based care outcomes depends on making real progress in the way doctors and health plans manage the most complex, sick and socially vulnerable populations. The right technology and care programs integrate and efficiently collaborate on care plans for physical, behavioral and social aspects of patient health and leverage clinically integrated processes across communities of care.
Interoperability and data liquidity: There is an unprecedented amount of data flying around the healthcare system today, a situation that presents an opportunity to provide better care than ever before. However, it also places a huge burden on physicians to integrate efficient workflows between myriad software systems. To succeed, physician practices must rely on technology that simplifies data disparity in complex healthcare environments and provides access to current, accurate and comprehensive data for care management and analysis.
Payer-provider collaboration: After years of sometimes contentious relationships, payers and providers are realizing that, under value-based care models, they need each other’s data and cooperation to work together towards the shared goal of better patient care and lower costs. Today, practice support resources and provider support centers have to be a part of value based care model–-a vital ingredient for the last mile of care delivery.
Performance tracking and trending: Physicians need more than just reporting tools and outdated portal information. Rather, they need updated, trustworthy insights for patient events, and performance goals complemented with quality metrics updates, current information on open care items, and real-time patient event notification.
While it’s still in the early days in the shift to value over volume, and it’s difficult to say exactly what form value-based care models will eventually take, it’s certain that coordination and collaboration are key to making that unavoidable transition a successful one.
Scott McFarland is president of HealthBI, where he leads the organization’s health information technology platforms and contact center solutions for providers, payviders and payers.
