The healthcare industry is under extreme pressure with escalating costs, an aging population, healthcare delivery disruption and increased regulatory demands. Organizations of all sizes are feeling squeezed by the everchanging pressures of an unsustainable system.
As we aim to actively move the healthcare ecosystem away from siloed processes, cumbersome data and misaligned incentives to one where information, people and processes are connected, organizations are struggling to strategize their diversification from fee-for-service to value-based care.
For most healthcare organizations, fee-for-service still dominates, making up the largest percentage of incoming hospital revenue. That said, many organizations are operating under some form of value-based care, whether through the Centers for Medicare and Medicaid Services (CMS), commercial payers, narrow networks or with their own employees. This leads us to a larger question: It’s not a matter of if or when, but how organizations can implement and operate value-based strategies.
Although the process is complex and will vary greatly based on regional and economic factors, it’s clear that healthcare entities must start planning their transitions now. CMS recently announced it expects all Medicare Parts A and B beneficiaries and most Medicaid beneficiaries to be in a value-based care relationship with accountability for quality and total cost of care by 2030. So, what should healthcare organizations consider when adopting value-based care strategies aimed to improve outcomes for individuals and populations and lower the total cost of care? Here are five areas to think about:
- 1. Organizational structure and proper governance
Managing an organization-wide shift to value-based care while still managing a fee-for-service business is no small task. As leaders look to align their networks of providers around a shared business model, it’s important to get the right structure, goals and incentives in place to support the transition. To be successful, organizations must develop a sustainable business model focused on lowering costs, improving patient outcomes through enhanced care quality and streamlining operational and IT support.
Successful value-based care models must have a committed and cross-functional leadership team focused on establishing strong governance and shared decision-making processes. Value-based care models also require network alignment on a core vision and strategy, pace of transformation, coordinated care processes, expansive data sharing, targeted outcomes and aligned incentives.
- 2. Unified technology platforms backed by a health IT partnership
Health organizations are looking for EHR-agnostic platforms and health IT partners that offer a broad range of solutions and services based on comprehensive longitudinal records that not only draw from clinical and financial data, but also social, environmental and behavioral determinants of health. They want technology that provides:
- Support for both fee-for-service and value-based care models
- Flexibility to meet their unique needs
- Open ecosystems that allow for point-of-care integration
Developing collaborative partnerships with an end-to-end, platform-based approach can help organizations minimize technology sprawl, reduce cost of ownership and create a coordinated user experience that leverages rich, robust data.
- 3. Optimizing and expanding the venue of care
Successful value-based care strategies must demonstrate proficiency in optimizing venues of care to improve health outcomes, lower costs and increase consumer access and satisfaction. They must be able to analyze and predict the unique needs of each individual and appropriately match them to the skills offered in their network. This can be accomplished by:
- Eliminating inappropriate utilization
- Targeting high utilizers
- Reducing network leakage
- Streamlining transitions of care
- Adopting telehealth – including e-visits, video visits and remote patient monitoring – and new age care management and coordination services, such as digital concierges and care coordinators
By digitizing a personalized care plan for each individual, organizations can go beyond the physical venue of care and expand coverage with new, more accessible models of engagement.
- 4. Consumer engagement
Organizations are looking to retain existing patients and recruit new consumers to grow their revenue. Providing convenient and cost-effective access while keeping patients in network can help ensure appropriate care coordination and reduce network leakage.
Success in value-based care models relies on changing consumer behavior through better education, increased engagement and personalized care plans, which can lead to outcomes such as better adherence to therapy recommendations, proper utilization of healthcare venues and healthier behaviors. Several studies have reported decreases in healthcare spend, such as hospitalizations and emergency room visits, when patients are highly engaged in their own care.
Consumers want a trust-based relationship with their healthcare providers. Whether they're focused on wellness and prevention or treatment of a chronic condition, they want to know they have an engaged partner who cares about their health.
- 5. Health and prevention strategies
Successful value-based care organizations demonstrate the ability to provide improved care coordination and purposeful focus on preventative healthcare. Chronic and mental health conditions account for 90% of total healthcare expenditures in the U.S. And, between 30% and 50% of cancers are preventable by avoiding certain risk factors and implementing key preventative measures. Prediction, prevention and proactive intervention can play key roles in identifying conditions early, initiating appropriate action and thereby improving health outcomes while reducing costs.
- What can healthcare organizations do now?
Regardless of where you are in your value-based care journey, it's imperative to build and maintain appropriate governance, develop proper technical and operational support structures and invest in growing the skills of your organization. The journey to value is not a sprint; it's a marathon. The winners in this changing landscape will be those that develop a sustainable business model focused on lowering costs and improving patient outcomes. Enterprise analytic strategies, network leakage prevention, improved therapy adherence and consumer engagement strategies pay dividends regardless of business model but are imperative for success in the value-based care space.
Remember, the same skills that serve organizations well in value-based care models can also help optimize revenue in fee-for-service models. The primary difference lies in the ability to identify and match patient needs to the right venue of care at the right time. But the time to start is now – giving yourself a runway to hone and mature your strategies as the future of value-based care accelerates.
Are you ready to advance your value-based care efforts while still supporting your fee-for-service business? Wherever you are on your journey, Cerner can help. Learn more about our value-based care solutions or schedule a meeting to discuss your needs today.