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The shift from fee-for-service healthcare to value-based care has been in motion since the passing of MIPPA in 2008, though the incentives from the Centers from Medicare and Medicaid Services (CMS) didn’t become mainstream until the Hospital Value-Based Purchasing Program began in 2012. Ever since, CMS has been introducing and modifying incentive programs to encourage hospitals and care facilities to provide comprehensive, coordinated care to reduce overall healthcare costs.
Existing value-based programs have faced criticism even amidst success. Facilities are still opting into these alternative payment models (APMs). While this can help some facilities take on risk at their own paces, the care centers that don’t participate are still using the fee-for-service system, which is less cost effective than value-based care. Additionally, value-based reimbursement doesn’t always take into account the additional factors impacting low-performing hospitals, such as patient populations with high rates of chronic illness or low rates of insurance.
However, for high-performing hospitals, value-based financial incentives are an effective tool for lowering care costs and reducing the incidence of unnecessary testing and procedures. Here are three ways you can maximize your value-based care success.
Primary care physicians are uniquely equipped to foster trust and meaningful relationships with patients and are the first line of defense when offering preventative care. Because primary care physicians work so closely and consistently with patients over many years, they can catch symptoms and illness while they’re still easily treatable. These providers can also curb habits that have negative impacts on patient health, such as tobacco use.
Another measure that could improve care delivery for primary care physicians is to create a team of preventative care specialists – including nutritionists, pharmacists, and wellness coaches. By building a support team around primary care providers, facility leaders can reduce the strain of education and communication on individuals by spreading responsibility across a small team. This could also help patients better understand the many ways they can approach improving and maintain their own wellness.
Under the current system, providers can opt into value-based purchasing initiatives, receiving bonuses for performing above average and being penalized for performing below the average. Some experts believe switching to a true value-based care system would be the most effective. This would entail giving providers a single lump-sum payment offered per patient per year, with facilities owning costs outside of that. If patient care is coordinated and high-quality, facilities will keep the remaining funds and determine how they can best balance risk.
Though this could be one solution to reducing costs, it does not necessarily account for patients who see a variety of provider types or who visit assorted care centers. Would each care center receive a lump sum? Would the care centers have to divide a single payment? The current system of incentive programs may be a step in this direction, particularly with the continued integration of payers and health systems, but it’s unlikely that we’ll be seeing a fully value-based system in the next 5 or 10 years.
Patients have a wide variety of facility types to choose from when seeking care and are often visiting care centers in various locations due to commuting and other travel. Collecting information and coordinating care for a single patient across disparate electronic health record (EHR) systems can be challenging. In 2010, Trenton Health implemented a Healthcare Information Exchange (HIE) to connect the multitude of EHR systems in use across the care sites in its network. This decision enabled the health system to manage data collection and verification, as well as manage risk and physician workflows.
The rapid consolidation of the healthcare market is also driving consolidation of EHR systems and other technologies. When companies merge or are acquired, organization leaders must decide whether to pick an existing system from one of the parties or to choose a new vendor. For any of those options, interoperability is the end goal. If patient data is inaccessible to providers, it is essentially useless in terms of care coordination and preventative medicine.
Hear first-hand experiences from industry thought leaders from Mayo Clinic, Dell Medical School & UT Health Austin, and more! This panel will cover topics ranging from:
Looking for more information on how value-based care performance data can benefit your organization? Definitive Healthcare tracks CMS program participation and financial metrics for over 7,900 hospitals and 800 health systems, as well as dozens of other facility types.
With access to Definitive Healthcare’s comprehensive platform, you can: