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How to Make Sure Value-Based Care is Done Right

It’s a critical time to take control of value-based care (VBC) and grab it by the horns. Innovation and execution in VBC are the best ways to manage medical costs effectively, maintain strong provider relationships and differentiate your healthcare organization in the market. Even with these opportunities, the country is still reeling from the implications of COVID-19…causing significant value-based care challenges.

Impact of coronavirus on value-based care

HealthPayerIntelligence reports, “…that the pandemic has had both positive and negative influences on value-based care progress and alternative payment model uptake… positively, many providers have gained a new perspective on the benefits of value-based care due to the pandemic. The fee-for-service reimbursement model failed them as in-person care shut down and they are ready to look into alternative payment models…Conversely, there are still spaces in which healthcare industry leaders have not thoroughly explored value-based care models and alternative payment models.”

The coronavirus pandemic has affected how providers and patients perceive value, according to the article:

  • For providers, there was a shift from volume to outcomes, from a fee-for-service mindset to a value-based care mindset. Although the pandemic had a slightly delaying effect on value-based care progress at first, in the first six months of 2021 payers have plunged ahead with value-based contracting, with some payers securing multiple value-based contracts.
  • For patients, broad exposure to telemedicine instigated a shift in how they wanted to interact with their providers and how they assessed the value of a provider visit. 

Some of the challenges

Payers and providers must align their definitions of value and communicate more effectively to succeed in value-based care, according to a 2020 Xtelligent Healthcare Media’s recent Value-Based Care Assessment.

Additionally, payers are often responsible for creating the bridge from fee-for-service care to value-based care. During the coronavirus pandemic, many payers seized the opportunity to transition provider partners into more economically stable, value-based care agreements. However, with an employer in between the payer and provider, these transitions might be more challenging.

Recognizing spaces in which value-based care has not been put into practice and implementing telehealth and alternative payment models in an effective way can help payers drive value-based care forward in 2021.

Evaluating VBC through provider intelligence

A recent RevCycleIntelligence article says that, “Many health plans are not taking advantage of provider targeting because they are currently:

  • Using a narrow set of internal metrics and missing insight on ideal provider partners: Many plans struggle to obtain the comprehensive insights needed to understand their optimal VBC targets. Data sources are fragmented across operational silos, and the data that is available to plans is typically limited to that payer, providing an incomplete view of provider performance.
  • Gathering data from multiple data sources, which is resource- and time-intensive: Even if health plans have access to robust and sophisticated data, collecting the data available is a laborious process that requires significant administrative investment. The most successful plans understand that provider contracting is a continuous process: They must be ready to develop new partnerships and modify existing models at any time. Having the right data in hand to make these decisions is a strain on resources, forcing many plans to resort to a simplified strategy that doesn’t tell the full story.”

A more intelligent approach to value-based strategy

A provider intelligence strategy that combines data across sources and captures a multifaceted snapshot of providers will help health plans target the right provider groups and align them with the best type of VBC arrangements. This approach will enable a high impact VBC portfolio and help health plans:

  • Improve overall medical trends
  • Reduce total costs
  • Decrease administrative costs
  • Improve quality
  • Enhance provider satisfaction

5 effective ways to evaluate value-based care

  1. Effectiveness and efficiency. Effective and efficient care are a joint effort that centers around ensuring that hospital patients receive proper care and the resources to coordinate future care to reduce readmission rates.
  2. Timeliness. Providing prompt patient care can positively affect patient experience and increase quality of care. Delays in care create can hinder the preventative aspects of the model.
  3. Safety. Quality care means safe care. Patient safety models are incorporated into value-based care models for obvious reasons, since a major emphasis in these systems is on prevention.
  4. Patient focus. Patients want to feel like they are being listened to and that their providers care about their health and well-being.
  5. Equitability. Equitability is critical in value-based care models. Equity quality measures encourage providers to provide care to patients from every portion of the population, regardless of demographic.

The future of value-based care

Moving from a fee-for-service to a few-for-value system will take time, and the transition has taken longer than expected. As the healthcare landscape continues to evolve and providers increase their adoption of value-based care models, they may see short-term financial hits before seeing longer-term costs decline.

However, the transition from fee-for-service to fee-for-value has been embraced as the best method for lowering healthcare costs while increasing quality care and helping people led healthier lives.

The best way to evaluate VBC

If you want to stay up-to-day on value-bases care and how it can help your healthcare operation now and in the future, simply call Blue Eagle Consulting at 1 (866) 981-1095, use the short and easy Contact Form at https://blueeagle-consulting.com/contact-us/, or send an email to info@blueeagle-consulting.com. We’ll be glad to help you understand and tap into the challenging and changing world of value-based care.

Reach out to us to learn more about what we can do for your organization.

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