Guest post by Suzanne Travis, VP, regulatory strategy, McKesson.
Shifting to value-based reimbursement (VBR) is a challenging journey, and trying to proactively manage risk at the same time only makes things more complicated. However, there are simple ways a provider organization can more proactively position their organization for a shift to VBR. While there is no fool-proof method or one-size-fits-all approach, here are four strategies that can help steer providers on the right path, no matter where they are in the VBR transition process.
Start with a program that aligns with organizational goals
Participation in alternative payment and delivery models are on the rise. The American Hospital Association estimates that more than 60,000 providers are participating in a delivery system reform model — and that number is growing. The overarching goal of implementing new health care delivery system models is simple: to provide better, more efficient and coordinated care for patients. However, each model has its own nuances and can sometimes require a different approach. Healthcare organizations should be well-served to take a deliberate path to succeed in their journey to value-based care. First, look at each model to understand how it measures and incentivizes participants and the type of care delivery changes it requires. Select models where you have an alignment on goals, room for improvement, and where you can start with upside-only incentives. It’s better to engage now, when participation can be voluntary and downside risk can be deferred.
Getting started is, of course easier said than done. The American Academy of Family Physicians found that a top barrier to adopting alternative care delivery models is a lack of understanding of the elements and actions for success. There are materials and organizations out there that can help guide the transition. For example, the Global Center for Health Innovation explains the models and provides guidance on questions to ask and tools to consider. The Office of the National Coordinator recently launched the Health IT Playbook that includes a state-by-state listing of federally funded sources of technical assistance to support practice transformation activities. Don’t let a knowledge-gap deter you from achieving your goals.
Be ready to act when new opportunities arise
New payment models continue to be introduced and new cohorts are being added to existing programs. Whether you are impacted by a mandatory model, such as the Episode Payment Model CMS recently proposed, or a new voluntary program is announced, be ready to adapt. Take for example the recently announced Comprehensive Primary Care Plus initiative. Participating practices have a choice of two tracks with the same care delivery requirements, but with different financial risk components. Both tracks aim to provide funding for infrastructure and process transformation. Keeping your finger on the pulse of these opportunities and being prepared to act quickly to engage can help you enter into programs that allow you to learn with less risk. If you know what your goals are, you’ll be able to spot the right opportunity to get started.
Partner with your vendors
As providers adopt new care delivery models and take on more risk, contracted vendors should be expected to engage as partners who can work collaboratively to solve new problems.
The goal of your vendor is to help your organization run more smoothly, but if they don’t know what you’re tracking towards, they will have difficulty helping you achieve your goals. Start by engaging your vendors early to find out how they can help with assessing your current cost and quality performance, creating dashboards to track progress towards goals, supporting new care processes, and providing clinical decision support to improve quality performance. Your vendor may also be able to help you network with peers at the same stage in transformation.
Tap into the consumerism of care for patient engagement
A patient’s understanding of their own health care, or lack thereof, can most definitely affect the ability to manage risk. “Health literacy,” or the ability to read, comprehend and analyze information as it relates to one’s own health, is imperative. The lower the level of health literacy, the higher the risk of an adverse outcome. To add more complexity to the patient engagement equation, “illiterate” patients are also more likely to be dissatisfied with the care that is offered, which can impact your bottom line.
Only 21 percent of surveyed consumers describe themselves as being “very engaged” in their healthcare. Providers that are relying on increased patient engagement to make their value-based care models work should prepare for an uphill climb. Healthcare organizations should consider patients’ preference for communication, access to personal health data, trigger points for stress or satisfaction levels and preferred technology operating platforms, just to name a few and take action accordingly. Once it’s determined where patients are in terms of preferences for engagement, the next step is to secure and deploy the tools needed to engage them.
Understanding where your organization stands overall is essential to determining where you’d like to be five or ten years down the line. Goals should be chosen with industry developments and reforms in mind. Only then can you truly begin to align your relationships — with both vendors and patients. Recent industry developments can — and have — brought forth a variety of changes, but if you embrace them, then you can reap the benefits along the way.