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3 keys to move from fee-for-service to value-based care

By Elizabeth Johnson, Contributing Writer at Arcadia
Data Management and Quality Population Health Management Quality Improvement The Schema Value-Based Care

In healthcare settings today, no one is sitting still. We cannot ask practitioners to add another thing to their workload; yet healthcare needs to change. It needs to meet patients where they are.

Doing that requires an industry that understands how value-based models can streamline the process of delivering care, while making that care better for the patient. Arcadia Chief Product Officer, Nick Stepro, recently spoke with Castell Medical Director and Interim COO, Dr. Will Daines, about realigning payers and medical providers around mutual benefits value-based care, the technology needed to deploy that change, and the outcomes that it delivers to patients, providers, and payers.

This discussion is now available as episode 4 of the Arcadia miniseries, The Schema (watch it here). Below, we summarize the challenges, the impact of strong technology and the benefits of transitioning healthcare to the new way of operating that Dr. Daines describes.

1. VBC is complicated — get everyone on board


We have to start in the position of improving healthcare, driving towards better outcomes at a lower cost, sounds unimpeachable, right? It sounds like the obvious thing we would want to do and it’s not challenging because we’re trying to talk people into a model of care that is worse for patients or higher cost, it’s hard to do because even though the objectives are unimpeachable, how you get there is really complicated.

Dr. Will Daines
Castell Medical Director and Interim COO

Better healthcare at a lower cost sounds like a no-brainer. But getting there is complex because there are so many different players with so many different goals.

There are several steps that must be taken in order to transform the industry:

  • Help each subsector of the industry understand how value-based care will be beneficial to them specifically
  • Align medical groups and payers around value-based concepts to streamline managing value
  • Maintain the individual uniqueness of medical groups during the alignment
  • Make it easier to provide great care with data analytic tools, population health support teams, and coding and documentation support teams

Once providers and payers realize their ability to push value forward and ease delivery of care, the needle begins to move toward value-based models.

2. Technology can augment providers’ abilities to perform


We think that you have to really put the provider team in the position to provide the best possible care. Nurses, doctors, advanced practice providers will run through a brick wall if they know it would be good for their patients. There is no shortage of motivation for those professionals to do a great job. We have to make sure that our tools augment their ability to perform as opposed to detracting.

Dr. Will Daines
Castell Medical Director and Interim COO

Technology can give providers a lot of information, but if it’s adding burden to an already taxed workforce, it’s not going to solve problems.

Instead, technology must offset workloads for providers and demonstrate a clear connection between the actions they need to take and the outcomes that they will create for patients.

For example, technology can connect coding and documentation with a better acknowledgement of a population’s illnesses. It can become a facilitator of better resources and programs that improve people’s health.

Technology in this role helps providers realize that coding is not just something they do because they’ve been told to do it, but it’s something that directly contributes to the health of their collective patients.

3. Don't forget to care for patients who are not in front of you


Part of what we’ve tried to go through as we’ve helped groups transition to value-based care is saying, ‘We can create room in your day to think about the patients who aren’t right in front of you. The patients who are in front of you today are going to get great care because they’re coming to see you. But what about the patient who’s too ill to make it in today? The patient who’s fallen through the cracks? The patient who was discharged from the hospital a week ago and their follow-up appointment isn’t for a month?

Dr. Will Daines
Castell Medical Director and Interim COO

Investing in analytics can enable whole person care. Setting up an analytical system that works involves focusing on the entirety of the problem, rather than an individual report.

When organizations design the questions they want to ask and the solutions they want to implement, they should involve an analytics team in the process. This will give them a very clear sense of what’s possible, what’s not possible, and what could be hidden in the data that they wouldn’t even think to look for.

Having essential analytical data in an easily accessible format gives providers the space they need to think about the patients who are not right in front of them. It also gives them confidence and trust to engage in team-based approaches that provide whole patient care.