Value-based care is evolving. As more healthcare organizations move toward pay for performance, there is a rising need for single care models that deliver whole person care. This results in a patient-first approach to multi-payer contracts.
This shift is made possible by standardization, automation, and consistency in the way providers categorize patients. CareAllies is at the forefront of value-based care, helping their partners deliver whole person care, manage payer relationships more efficiently, and perform well on their contracts.
CareAllies’ Director of Population Health Solutions, Becky Trotter, recently sat down with Arcadia Chief Executive Officer, Michael Meucci, to discuss how these novel approaches to value-based care puts patients and their privacy first, delivers better point of care support with insightful and actionable data, and improves overall quality outcomes, including reduced readmissions and ER visits in vulnerable populations.
The discussion is now available as episode 6 of the Arcadia miniseries, The Schema. In this article, we collect some of the greatest insights from the discussion that will help you begin to think about how to put the patient first in your value-based contracts.
We believe if you’re identifying patients in a really great way, if you are getting those patients in to be seen, the dominoes kind of start to fall. So you are identifying their chronic conditions, you’re managing their chronic conditions. And in turn, you’re improving their quality outcomes.
At the end of the day, providers are in the business of delivering great care to patients. Under value-based contracts, the success of these efforts is measured by quality outcomes for patients. Reduced readmissions and frequent ER visits, for example, results in utilization that returns favorable.
A good indicator that an organization will perform well is that they’re proactive in addressing conditions through targeted identification, and they’re consistent in the way they follow up with these patients. If a patient has diabetes, Trotter says, it doesn’t matter what payer they have a plan with. The provider who executes the same clinical care across the board and delivers the right care to this patient will achieve the best possible quality outcomes.
It’s important to spend time evolving the way you approach value-based care for this very reason. Reducing the administrative burden on providers, using technology to augment the ability to perform, and helping providers navigate contracts and changing regulations will ultimately give them the ability to spend more time in the exam room and deliver necessary services to patients.
When I talk to our providers, one of the things that I remind them is, you know what’s happening within the four walls of your practice. And there’s a lot of other things happening out there, especially in our more vulnerable patient populations where they might be seeing multiple specialists, you just don’t have visibility and insight into that. And so being able to aggregate data and then push it back to the provider at the point of care, so they know the true things that they need to talk about the patient on.
Evolution in value-based care requires a fair bit of revolution. Trotter says it’s all about breaking down walls and making information widely available across specialists, primary care physicians, and even hospitals, so that everyone knows what is happening to their patients across the full continuum of care.
Communication between providers is essential to the success of a clinically integrated network. Access to clinical and EMR data across services is a way to automate this process. A provider doesn’t necessarily have the time to Zoom or Slack their colleagues, and access to the right data at the right time helps all members of a patient’s care team get visibility into that patient. They can also automate notifications to all care providers when a major medical event occurs. This type of real-time automated communication empowers a care team to jump in and deliver care that’s needed and helps them prioritize care delivery.
One more way to break down walls and evolve VBC is to focus on social determinants of health. Access to SDoH data changes the game in identifying the need for special programs. Patients with transportation challenges, for example, might benefit from a program that brings care to their home through home-based vendors. If it’s a population-wide challenge, providers can deploy community resources like bus passes. Identifying these barriers is the first step in breaking them down.
There’s not a day that goes by that I don’t think about patient privacy and how we navigate that, and it changes. I mean, seven years ago people were a lot more hesitant across the board, not just clinicians, but across the board. And then now you think to where we are and we’ve got mandates and rulings coming down that we have to share data and we have to make data available. And so how do you kind of guide people through that is a big challenge for us. I think one of the biggest tools in our strategy is data security.
Sharing data can be tricky. Some providers may be worried about infringing on their patients’ rights to privacy. Others may be worried that it could be used against them in performance reviews.
But transparency is key to overcoming these challenges. Helping providers see that access to other providers’ data will help them provide better care to patients will also warm them to the idea of sharing their data. Ensuring that you’re working with a vendor who can demonstrate that it has the ability to segment and firewall data is crucial to the strategy.
HIPAA, the Healthcare Information Portability and Privacy Act, addresses this very need for data portability. It encourages access to de-identified and siloed data that can help provide better care to patients and populations.
