The value of value-based care

Sept. 14, 2018
Janette Wider, Editor

It comes as no surprise that value-based care is one of the most talked about topics in the healthcare space right now … it’s been a hot topic in the past, and will certainly continue to be one in the future. Simply, value-based care is a model in which providers are paid for keeping patients well (fee-for-value) as opposed to the number of services they provide (fee-for-service). I see tremendous value in value-based care, and so do many HIT professionals.

This edition, I interviewed a roundtable of industry experts on the topic of value-based care. The number one thing I learned is that the time to move to value-based care is now. Although there are challenges and obstacles related to moving toward value-based care, there are ways to overcome them. Value-based care will see some serious advancements in the years to come.

Heather Lavoie, Chief Strategy Officer at Geneia responded to my question about when the right time to move to value-based care is by saying the following: “Ideally, the time is now. As I’ve said many times, the value-based care and population health train has long since left the station. In the last few months, CMS has publicly recommitted to value-based care. CMS Administrator Seema Verma has shared her concerns about the acute need to bend the cost curve and for more ACOs to take on downside financial risk. She told attendees at the American Hospital Association Annual Meeting that failure to assume two-sided risk may result in significant changes to Medicare ACO programs.”

If CMS is recommitting to value-based care, your organization should be too. The train may have already left the station, but it isn’t too late to catch it at its next stop. The idea of transitioning to value-based care may seem daunting, considering the challenges, but there are ways to utilize healthcare IT overcome them.

Dr. Andrei Gonzales, AVP, Value Based Payments at Change Healthcare gives some tips on how to use data to move to a value-based system, “… analyze and understand your position in the community by looking at data across the continuum of care by episodes of care that will show opportunities for improvement in care quality, outcomes and cost. This will help your organization understand where you are performing well today and where you can improve. This will also help your organization understand where you need to add care coordination and the level of accountability your organization is going to take.”

I imagine that using data across the continuum of care by episodes of care will be the norm for organizations, as well as other advancements—including using a patient’s zip code, which I’m glad to see after my last editorial on the social determinants of health (SDoH).

Niki Buchanan, Business Leader at Philips Wellcentive explains, “The ZIP code is one of the most important numbers to predict a patient’s health status—it can tell physicians and care managers about a patient’s access to healthy food, environmental exposures, education and income levels, and neighborhood stress levels. Social determinants can help care teams address health needs and tailor care management plans based on the patient’s economic, educational, and environmental context. Through predictive modeling, social determinants can help healthcare organizations determine at-risk populations and identify avoidable healthcare costs. And finally, social determinants improve the fairness of provider profiling by using the populations’ social risk to adjust quality and performance measures.”

I was very happy to hear this comment from Buchanan. Using SDoH to predict patients’ health status will make things easier for those living with chronic illness, especially in lower income areas. Providers can focus on making their community healthier, saving money in the long run.

In conclusion, value-based care isn’t going anywhere. Now truly is the time for your organization to embrace it and make the transition. As always, thanks for reading. I welcome your feedback at [email protected].

Top 10 IT consultancies for value-based care transformation and strategy, according to Black Book:

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