Partners, Patients Key to Achieving Value-Based Care Results

November 01, 2019 - For over a decade, the healthcare industry has been shifting provider reimbursement from a fee-for-service system to one based on the value of services provided to patients, and new payment models have been the driving force behind this shift to value-based care.

Bundled payments, shared savings, capitation, and other alternative payment models tie reimbursement to patient outcomes, cost performance, and other metrics to incent providers to improve outcomes and patient satisfaction all while lowering the unsustainable trajectory of healthcare costs.

But providers and payers have both been plagued by challenges with implementing these new models. Chief among those challenges is technology.

A recent survey of over 1,000 healthcare leaders across the provider, biotech, financial services, staffing, life sciences, IT, and consulting verticals found that a lack of appropriate health IT software is still impeding value-based care adoption.

An earlier report from the Healthcare Financial Management Association (HFMA) also found that payers and hospital finance executives agreed on something: neither have the IT to successfully implement value-based care.

READ MORE: Healthcare CFOs Look Forward to Value-Based Care, Consumerism

Technology, and specifically data analytics, is essential for value-based care delivery. Providers and payers have little chance of saving money while improving outcomes if they cannot track clinical and financial performance.

And like providers, payers, and other stakeholders from past events, speakers and attendees at Xtelligent Healthcare Media’s fourth annual Value-Based Care Summit in Boston last month stressed the importance of data analytics tools, clinical decision support software, and other technologies. However, technology took the passenger seat this year.

This year, the industry experts focused on the humans behind technology, payment models, and most importantly, in front of clinicians.

Providers need a partner for value-based care success

Healthcare has many moving parts. From payers, vendors, and pharmaceutical companies to patients, caregivers, and other healthcare providers, physicians and their team must interact with each player in the space to deliver quality care.

In a fee-for-service world, these relationships were primarily business transactions. Sick patients go to the doctor, the provider delivers care and bills the payer for the encounter, and finally the payer reimburses for services delivered.

READ MORE: Good Data, Better Value-Based Care Can Boost Population Health

But value-based care hinges on partnerships, not business transactions, speakers at the Value-Based Care Summit emphasized.

For example, Larry Blosser, MD, the corporate medical director of Central Ohio Primary Care Physicians, highlighted his partnership with Humana. Central Ohio Primary Care Physicians went from a shared savings arrangement to capitated payments with downside risk for about 30,000 Medicare Advantage patients with the help of Humana.

Blosser stressed that the organization was able to make the shift to a risk-based model by sharing a common goal with Humana. The payer also went beyond the traditional relationship to not only give Blosser and his team the data they need to manage patients in a value-based world, but also glean insights from the information.

Humana’s vice president of the Office of the CMO Worthe Holt, MD, also elaborated on how the payer is developing partnerships with health IT companies like Epic and Microsoft to get the information needed for value-based care in the hands of providers.

Speakers throughout the event shared similar stories of partnerships. Providers are partnering with payers to develop the right value-based care models for their practice. They are also partnering with other providers across the care continuum, as well as organizations in the community, to control patient outcomes and total cost of care.

READ MORE: Best Practices for Value-Based Purchasing Implementation

Having open, honest discussions among all stakeholders will continue to be a challenge as the industry shifts from the fee-for-service system, which created distrust. However, those conversations and the relationships coming out of them will be critical to getting value for the most important stakeholder – the patient.

Creating value for the patient

The industry constantly debates what the “value” in value-based care means. But this year, industry experts emphasized the role that patients play in defining value.

In his keynote presentation, Larry Moss, MD, president and CEO of Nemours Children’s Health System, asked what the healthcare industry is truly paying for with value-based reimbursement if providers are not addressing the real driver of poor health and outcomes. For Moss, the driver is social risk factors.

A third of patients in the US frequently or occasionally struggle with social determinants of health, particularly housing, food, and transportation security, a recent survey by Kaiser Permanente found. With these factors contributing to the majority of a patient’s health outcomes, value-based reimbursement models need to address social determinants to truly deliver value-based care, Moss explained.

In his presentation, Moss shared a story about Jamal, a pediatric patient who died from a gunshot wound. But Moss does not attribute the boy’s death to gun violence. Instead, he asked the audience to consider asthma as the true cause of death.

Jamal had suffered from asthma complications as a child, which pulled him out of school and his regular community activities. As a result, Jamal’s mother said that her son started interacting with “the wrong crowd,” which led to a gunshot wound.

The example is extreme, but it demonstrated what many experts at the Value-Based Care Summit felt. Alternative payment and value-based care models must address social determinants of health to effectively improve outcomes and lower costs.

Addressing individual patient concerns will be key to achieving value-based care success, experts agreed. While alternative payment models enable providers to share in savings and earn incentive payments, the models cannot truly achieve value if they do not improve outcomes while also enhancing the patient experience.

Price transparency will be a key way providers add value, a panel explained. Engaging with the community is another strategy for providers, another speaker said.

Value-based care is moving beyond implementation and that will require more emphasis on the patient and other partnerships. Accounting for the people who are delivering and receiving care will be essential for succeeding in this new phase of value-based care.