Value-based care (VBC) is a provider payment model based on incentivizing high-quality healthcare rather than quantity of services. Overall, the goal is to improve the lives of patients while reducing cost of care. From a healthcare provider perspective, here are five key strategies to implement and improve value-based care:
- Identify patients with the highest risk
- Address patients who need care
- Encourage annual wellness visits
- Keep open communication with provider-relation reps
- Be open-minded to succeed at value-based care
Shifting from a fee-for-service model to value-based care might seem overwhelming, but with reliable analytics and a dedicated team, your organization can make the transition confidently.
1. Identify patients with the highest risk
The first essential element of implementing value-based care is having an EMR that can help you identify where you have gaps in care. A healthcare analytics solution can help transform your data into actionable insights. It allows you to aggregate patient data to make informed decisions and identify high-risk populations.
Specifically, a healthcare analytics platform leverages the following data types to provide a comprehensive patient risk profile:
- Electronic health records (EHRs)
- Claims data
- Social Determinants of Health (SDoH) data
- Patient demographics
- Clinical risk scores
- Health risk assessments
The data from these sources are processed, integrated, and analyzed to discover patients facing the highest risks. Gathering data from multiple sources enables healthcare providers to make evidence-based decisions for resource allocation based on data analysis, risk stratification, and risk scores.
2. Address patients who need care
Once you identify patients with high risk, set up an outreach strategy to contact these individuals. Encourage appointments via phone calls, text messages, emails, and more. Some patients may only seek care when they are experiencing an acute injury or illness. For these cases, take proactive steps to identify any gaps in care during the visit. This way, you can identify any missed prevention opportunities, such as screenings.
While fee-for-service models may focus on quantity, value-based care encourages detailed services customized for each patient. Though more involved, this strategy ensures patients receive the right care at the optimal time and in the right setting.
This may include follow-up visits, medication management, and enhanced care coordination to ensure patients receive prompt and effective care.
3. Encourage annual wellness visits
If possible, employ mid-level providers to perform annual wellness visits for your patients in value-based care. For some, this can also include annual comprehensive diabetic screenings. During these visits, health assessments can be made that may identify risk factors and positive lifestyle changes patients can make.
Utilize lifestyle and behavioral assessments to discuss stress levels, mental health, nutritional habits, and exercise habits to assess a patient’s risk factors and provide personalized guidance. With continued health assessments and discussions, the provider-patient relationship can be enhanced over time to encourage timely care management.
4. Keep open communication with provider-relation reps
Understand the value-based care incentive targets that your payers require so you can build a good relationship with your provider relations representatives. Be aware of the quality measures that you are being scored on and know how bonuses are calculated to achieve the best outcomes.
Continue to collaborate as you gather new insights and feedback from the care delivery frontlines, so you can navigate the requests from each payer while hitting the necessary performance benchmarks. With an open communication policy, you can proactively resolve disputes and stay competitive in value-based care arrangements.
5. Be open-minded to succeed at value-based care
Consider having a quality data coordinator or case manager come into your network’s practices and work with you to create a plan for closing gaps. Sharing data across providers and with your VBC service vendor is essential to succeeding at value-based care. Together, you can explore new solutions which may involve:
- Accelerating collaboration between multidisciplinary care teams, including nurses, care coordinators, and pharmacists
- Embracing healthcare analytics and evidence-based practices to drive more informed care decisions and enhance resource allocation
- Evaluating and adjusting care plans and interventions based on patient outcomes and additional feedback
When sharing data across your care network, be sure to choose an agile and secure solution that can integrate with multiple platforms while keeping patient data safe. Cloud-based analytics tools can eliminate chart chasing and get the right data ready at the point of care.
Value-based care implementation: Next steps
Providers can help implement and improve their value-based care payment models by taking these 5 key strategies into consideration. Value-based programs aim to reform how healthcare is delivered and paid for, with the end goal being better care, improved costs, and an overall healthier population.
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