Dr. Erkan Hassan

Monthly Writings

Evaluations and reviews of the latest in the field.

Implementing Value-Based Healthcare for Success

After reading this article, you will be able to define the various value-based payment models and list the facilitators and barriers to a successful program.

SUMMARY:

  • Value-based healthcare aims to provide patient-centered care by aligning provider incentives with outcomes.

  • This is a complex challenge, with heterogeneous and inconsistently reported results.

  • Achieving success in implementing value-based healthcare depends on recognizing and managing the factors that promote or impede its effectiveness

COMMON PAIN POINTS

  • Management: Lack of consistent leadership

  • Data: Inconsistent, patient data siloed across systems

  • Model Complexity: Lack of transparency on incentives to providers

  • Patient Engagement: Patient perspective not taken into consideration

  • Regulatory: Unstable regulatory environment

REVIEW

ALTERNATIVE PAYMENT MODELS:

  • Traditional fee-for-service payment models, pay providers for each service.

  • Value-Based payment models shift from volume to value, and link payments to quality, outcomes and efficiency.

  • There are several types of value-based payment models.  The most common are:

    • Pay for Performance – Fee for service plus bonus payments for quality.

    • Shared Savings – Providing care at a cost below a certain benchmark for a patient population.

    • Bundled Payments – Payment for services related to a specific episode of care.

    • Population-Based – Global payment to manage the overall care for a defined population. 

OUTCOMES:

  • Conflicting results have been reported with value-based programs based on:

    • Program design

    • Patient population evaluated

    • Parameters measured

  •  Outcomes Reported

    • Care quality

    • Cost savings

    • Provider Experience

    • Patient Selection and Experience

FACILITATORS:

  • Many factors can help facilitate a value-based care program.  The main areas which help are:

  • ORGANIZATIONAL FACTORS:

    • Leadership: The most consistently reported facilitator; bringing new ideas, continuously improving and evolving approaches over time.

    • Resources: Those necessary for appropriate design of program, and improved implementation.  Includes financial, time and human capital

    • Tailored Business Plan: Define the vision and strategy.  Provide a structured, clear, and goal oriented process.

    • Organizational Structure: Convert to a disease oriented organization. Most systems remain in silos and is difficult to associate outcomes with costs and patient continuity.

    • Communication and Education: Clinical staff and Patients.

    • Legal & Regulatory Updates

  • OPERATIONAL FACTORS

    • Multidisciplinary team: Engaging all clinicians involved in the care of the patient over time.

    • Care Transition Integration: Ensure seamless patient management throughout patient journey.

    • Standardization of Outcome Measures:  Data transparency and benchmarking. Real-time data sharing mechanisms.  Accessibility of data and outcomes.

    • The Patient Perspective: Include the patient’s point of view to align patient experience with how the team provides care.

    • Robust Clinical Dashboards

    • Facilitate Communication between providers and patients.

BARRIERS:

  • Insufficient funding

  • Resistance for providers to adopt value-based programs – reliance on fee-for-service model

  • Lack of IT infrastructure

  • Lack of multidisciplinary care approach in organizational structure

  • Lack of data collection process

  • Misaligned financial incentives

  • Lack of resources for adequate data collection & analysis

 VALUE-BASED CARE IMPLEMENTATION STRATEGIES

  • Comprehensive, multi-level care approach: Multidisciplinary team of care delivery across patient journey care transitions.

  • Care provided at the appropriate level of care with improved follow-up

  • Improved structured care processes:  Standardized Care Plans, mapped out care processes with roles and responsibilities clearly established.

  • Assessments:  Patient population level dashboards and reports, Clinical outcome measures, Dissemination of data in an efficient manner, Benchmark outcomes between sites, Trending data, Patient-reported measures, Costs.

CONCLUSIONS:

  • Value-Based care aims to deliver high-quality, patient-focused care at greater value.

  • These programs have not uniformly achieved the desired goals.

  • A successful program necessitates an understanding of the various models, risks, approaches, and ways to overcome the known challenges.

value-based care programs come in several different forms.

Successful value-based programs have unique challenges with inconsistent RESULTS reported.

Identifying and managing the relevant factors for success are critical for effectivenss

Do not leave this to chance, - let’s have a brief chat to discuss your unique situation

Erkan Hassan