Shifting to a Value-Based Care Model
Fee-for-service healthcare has been in place for decades; by some measures, even centuries. It’s all we’ve ever really known, which means there’s a whole set of systems to unravel — and behaviors to unlearn — in order for value-based care to thrive as a viable replacement.
As is often the case when traversing new territory, time-tested roadmaps and tried-and-true best practices are hard to come by. Add to that the fact that value-based care, especially in its infancy, is heavily driven by trial and error, as care teams are tasked with finding the right balance between quality and cost to deliver the highest value care.
Before implementing a value-based care model, it’s important to recognize that we’re still very much on the cusp of the shift, which places the responsibility with current healthcare stakeholders to carve the path. Here are four essentials you’ll want to have in place to successfully lead the charge toward value-based care within your organization.
1. An Understanding of Fee-for-Service vs. Fee-for-Value
This might sound like a no-brainer, but again, value-based care is still in the early stages. Shifting the mindset of healthcare staff from volume to value requires a contextual understanding of how their efforts contribute to the health of patients, the organization and the system as a whole.
Education is key to ensuring incentives and resources are aligned toward the needs of the patient. It’s an effort that must extend to all stakeholders — particularly those most focused on the bottom line. As Modern Healthcare notes, many value-based initiatives aren’t immediate profit-drivers — and hospital boards likely aren’t unanimously well-versed in population health and value-based care — necessitating transparency and education from management on how the organization’s initiatives are driving longer term value.
2. A Data-Driven Mindset
In a value-based care environment, decisions are driven largely by data, including the decision to make the transition to begin with. Evaluating where you are as an organization and what’s impacting the communities you serve will allow you to determine whether you’re in a position to adopt what is an inherently risk-based model, or what steps you need to take to get there.
Because there is no universal benchmark against which to measure the success of value-based care, the metrics will vary largely between organizations, making data essential to substantiating your efforts. This is where trial and error comes in. As Jason Goldwater, Senior Director at National Quality Forum, explained for EHR Intelligence, implementing a set of quality measurements is essential to evaluating provider performance, but it’s the ability to leverage these measurements to identify gaps, course correct as necessary and drive progressive improvement in quality that’s the real marker of success.
3. A Whole-Person Approach
Vital to the success of value-based care is having a comprehensive view of the individual — medical, behavioral, social and economic conditions included — to ensure care is coordinated around the needs of the whole person.
“If a person is both food and housing insecure, how do we address that?” posed Taylor Justice, co-founder and president of Unite Us, during a keynote on social determinants of health at Momentum 2019. “If they’re receiving food and don’t have a place to put it, it’s going to go bad. We need to start looking at people holistically in order to correct the supply chain.”
4. Commitment and Capacity to Invest — With a Bit of Patience
If it seems like value-based care has been slow on the uptake, that’s because it has — and it will be for your organization, too. Systematically transforming the way we deliver, manage and measure healthcare requires a significant cultural shift at both the organization and industry level. But without full buy-in and participation from payers, providers and policymakers, progress will be limited. While organizations must be willing and able to invest in the necessary infrastructure and implement tactics that are going to drive annual results, it’s important to realize that the large-scale impact won’t be immediate.
“It’s a systematic change,” said Justice. “We can’t replace decades of inefficient workflow in 12 months — we have to have a long-term vision.”