Procuring Sustainable Success with Value-Based Care Models
By Dustyn Williams, MD
All healthcare providers want the same things: better health for their patients and lower costs. Conceptually, value-based care achieves this shared goal by creating the incentives for all involved to provide better care and secure improved outcomes. Yet this approach lacks the appropriate framework and tools that enable and equip clinicians to achieve value-based outcomes.
Adding to this dilemma is the lack of an appropriate definition of “value” that would enable healthcare organizations to truly comprehend what constitutes “value-based care” and how to implement a successful, sustainable value-based model. True value is realized when efforts are focused on reducing costs and achieving enhanced outcomes rather than simply on attaining quality metrics.
Although the utilization and achievement of these metrics is a step in the right direction to positively impact care quality and outcomes, it’s not enough. Checking off boxes indicating that best-practice protocols are being followed does not necessarily equate to better outcomes or improved financials. Closing this gap between incentives and outcomes requires clinical care to evolve to reflect proactive management of chronic disease and promotion of patient wellness. Incentives alone are not enough; clinicians must also have access to the appropriate tools to achieve those quality goals.
The good news is that value-based payment models are providing the necessary impetus for the creation of radical disruptive practice patterns and new models of care. For instance, uptake of Internet-based care delivery that enable more proactive treatments is on the rise, particularly with chronic illness.
Value-based care is also a significant catalyst of advancements in telehealth solutions. These interventions are effectively disrupting traditional care models by providing the necessary best-practice based infrastructures and tools needed to proactively and effectively address chronic health conditions while seamlessly integrating into provider workflows.
Consider diabetes management. Despite the challenges faced with self-management of their condition, diabetic patients spend an average of just two hours per year with their primary care provider. Further, while physicians strive to provide patients with best-practice knowledge for controlling A1c levels, poor retention of medical information and rapidly changing effects of diabetes put patients at risk for serious health conditions and preventable hospitalizations. Clinical and financial impacts stemming from uncontrolled diabetes greatly influences the steep costs of the condition, averaging $176 billion nationwide each year. Patients and providers must have access to tools that enable enhanced collaboration and ongoing care monitoring to improve outcomes and expenditures for diabetes, as well as other chronic conditions.
Telehealth solutions fill this gap. Features such as smartphone-enabled provider feedback loops can now rapidly deliver easily-understandable, actionable information to patients to facilitate engagement, compliance and sustainable improved outcomes. By empowering patients to effectively self-manage their chronic conditions, long-term care costs to health plans and risk based-entities are significantly reduced, along with the steep costs associated with emergency room visits and hospital admissions.
Improvements in the health management of high-risk patient populations secure enhanced Healthcare Effectiveness Data and Information Set (HEDIS) performance measures and Star ratings for health plans, along with improved Medicare Access and CHIP Reauthorization Act (MACRA) and Merit-Based Incentive Payment System (MIPS) outcomes for providers.
Additional issues impacting the efficiency and success of value-based care include resistance to change and slow adoption of innovative care models. Industry laggards continue to stunt the progress made by early adopters of value-based care as they consume more resources than are saved. Ultimately, payers and providers must be willing to accept and adhere to new models, which will be helped along by the evolution of technology and processes, such as telehealth, capable of truly impacting care quality, outcomes and expenditures.
When risk is shared and incentives are aligned, value-based care models can enable providers to ultimately reduce expenditures and enhance patient care. If healthcare facilities provide quality care and cost-effective treatments that yield optimal outcomes, both patients and the healthcare system, as a whole, will benefit. Conversely, if there is no alignment, value-based care will collapse under the weight of a reimbursement structure that continues rewarding utilization. For instance, hospitals may continue to benefit from prolonged lengths of stays, while patients are buried under a mountain of medical bills and struggle with uncontrolled chronic diseases.
By delivering proactive, trusted information directly to patients, disruptive technologies fill a critical gap in population health and care management. The key is ensuring that information has been carefully vetted by a physician capable of making necessary adjustments based on the monitoring of a patient’s health in real time along with additional environmental factors such as food intake. This ensures that these interventions enable improved patient care outcomes while strengthening revenues by avoiding penalties and increasing profitability through performance-based bonuses.