The Centers for Medicare and Medicaid Services have encouraged physician practices to adopt a value-based care payment model since 2010, following the passage of the Affordable Care Act. A number of models have been tested in order to improve patient outcomes and experiences while reducing unnecessary healthcare expenditures by incentivizing clinicians to provide preventive, proactive, and appropriate care. Ensured health equity has been a recent focus.
As a result of value-based care contracts, many practices received regular payments per patient despite a significant decline in service volume during the peak of the COVID-19 pandemic. It may be difficult for you to maintain profitability under Value-Based Care if your practice was not among them. Your practice may struggle to understand contract terms, lack the data analytics necessary to manage patient populations, or fear you won’t be able to make contracts profitable.
There is no question whether or not value-based care will become a reality. Fee-for-service payment is simply not sustainable. You should consider strategies to make these payment models profitable for your practice even if your practice isn’t ready to move to Value-Based Care right away.
If you’re ready to switch practices, here are seven strategies to ensure success.
1. Negotiate Contracts that will work for your practice:
The priority of your practice is to make sure its patients receive the quality care and outcomes they deserve. The priority of a payer is to minimize their financial liabilities. Even though these priorities are diametrically opposed, when you build trust and good communication with payers, you may be able to negotiate a contract that:
- Calculates realistic capitation/reimbursement schedules based on your patient panel’s risk/utilization profile.
- Provides access to patient utilization data to guide efficient resource allocation and identify patients requiring extra care management support during periods of high utilization.
- Rather than metrics that you have little control over or visibility into, focus on metrics that you can realistically monitor and manage.
- Ensures that financial performance metrics, such as MLR targets, are set based on realistic thresholds and that payers share revenue and cost metrics algorithms.
- You can be sure that the physicians in your practice will buy-in if it aligns with your financial and patient care goals and values.
Make sure you perform a thorough analysis of your practice’s historical performance. Include your patient panel’s historical statistics regarding office visits, revenues, and patient risk scores.
- Improvements in quality and outcomes will require what they need.
- The most effective ways to reduce the unnecessary use of expensive treatments, services and facilities.
- Your practice needs additional staff and technology resources to manage contracts.
Consider hiring a consultant to assist you in evaluating your financial opportunities and negotiating on your behalf.
2. Maximize the efficiency and effectiveness of limited resources:
It’s impossible for you to provide continuous care to every patient on your panel because of current staffing constraints across the industry. As a result, you should develop a strategy to provide dynamic care management services targeted at patients entering or transitioning into high utilization periods (e.g., cardiac/cerebrovascular events, oncology events, etc.). Those patients who have consumed the most health care services in the past year are now on the backside of the curve, returning to a lower level of utilization after their health care event has already passed.
Identifying high-risk patients allows you to develop workflows that guide them through their high utilization period with close monitoring and care management. To gain insight into issues your staff has the expertise, authority, and opportunity to resolve, find a technology solution that integrates data and analytics technology with your EHR systems. Focusing your limited staffing resources on those patients who will benefit most from care management maximizes their efficiency and effectiveness.
3. Collaborate with partners to coordinate care:
Every clinician must have an understanding of when other providers have seen their patients, what treatments and medications are prescribed, whether the patients are following their prescribed treatments, how often they have visited the emergency room, and even if they have been hospitalized in order to provide quality care.
Connecting with medical specialists and continuing care providers with aligned goals and incentives is the easiest way to build collaboration opportunities. Through technology, you can automate collaboration, share patient data with partners, and align on care pathways to ensure seamless transitions of care.
4. Invest in Technology that is interoperable:
Your practice will suffer significant workflow inefficiencies if your technology platforms cannot communicate with each other. Interoperable technology means that the data in one system can be accessed and utilized in another. If you update your systems — revenue cycle management, scheduling, staffing, patient engagement — make sure they integrate seamlessly with your EHR. Consequently, clinicians will be able to access information and insights that will drive critical health discussions, decisions, and orders more easily.
5. Update practice workflows and analytics Capabilities:
Invest in technology that will increase the effectiveness of your face-to-face time with patients and facilitate care and transition management. If you want to keep your risk scores current and ensure accurate reimbursement, consider options such as face sheets that include risk analyses, automated scheduling for annual wellness visits, email alerts for recommended tests and screenings, patient referral support, HCC updates to keep your risk scores current and ensure accurate reimbursement, and notification when a patient is ready to be transitioned.
6. Focus on the healthcare Issues your clinicians can act on and resolve
Your Value-Based Care contracts may prove difficult to meet if you collect patient data through your EHR but are unable to access, analyze, and act upon it quickly and easily. With the right solution, you will be able to identify and quantify the risks associated with your seriously ill patient population now, including cost and utilization risk, medication compliance, mortality risk, and psychosocial issues that are hard to identify and quantify remotely. In addition to monitoring and managing their care, it should help you identify the health issues that you have the expertise, authority, and opportunity to address.
7. Be Proactive in your move into value-based care
It is imperative to understand the landscape, form partnerships with like-minded providers, and have the resources you need to make the transition successful when you are ready to embrace Value-Based Care. By using the right strategies, technology, and collaboration, you can not only meet the quality and cost objectives of those contracts, but also increase work satisfaction and achieve greater financial and clinical success.
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