The following is a guest article by Hugh Lytle, Founder and CEO at Equality Health.
The transition from fee-for-service medicine to value-based payments represents the greatest shift in healthcare in more than a century; according to CMS, by 2030 the vast majority of this country’s estimated $6.8 trillion healthcare spending will be tied directly to patient outcomes and satisfaction.
This shift represents a material win for patients – but what of the providers who deliver their care? Some 56% of primary care providers (PCPs) are concerned about the impact that value-based care (VBC) programs will have on earnings, practice operations, and workforce burden – impeding their ability to deliver high-quality care, fully counter to the tenets of the value-based care revolution.
Further, as is often the case, PCPs who serve the most complex and underserved patients face the most significant challenges in the transition to value-based payment models. As a result, provider burnout and attrition is sky-high – and in underserved communities, already limited access to healthcare is dwindling further than ever before.
The transition away from fee-for-service medicine seems a daunting undertaking for most independent PCPs, but value-based care is here to stay. So how can practices effectively partner with health plans, improve outcomes, satisfy reporting requirements and maintain their financial success in a rapidly changing healthcare environment? And what are some proven strategies and technologies to efficiently manage risk-based contracts?
Easing the Administrative Overload
The sheer number of disparate value-based contracts can be overwhelming for an independent provider practice to manage. The average practice participates in 12 health plan contracts — that’s 12 unique sets of contract expectations for a single practice to manage. Within those contract expectations, there are typically different targets, thresholds, and methodologies for the practice to measure and achieve success with no clear path to sustainable reimbursement.
Further, each health plan contract is supported by a unique, plan-specific dataset, unique patient eligibility criteria, unique mechanisms for submitting information, and unique performance reports. Using 12 distinct payer-specific portals with varying degrees of functionality and disparate user interfaces is unmanageable for most practices.
To be successful in value-based care, practices need better tools and resources that distill the complexity of value-based contracts and allow providers to do what they do best – practice high-quality medicine. Workflows for providers and their staff must be tailored to support best practices for value-based performance – and supporting technology must be sophisticated enough to satisfy health plan VBC requirements, so that practice staff doesn’t have to do so at the point of care.
Turning Data into Information
Practices are swimming in clinical data, thanks to the rise of the EHR – but most of that data isn’t structured to support practices in maximizing their value-based contract performance. How well are you managing chronic conditions? Can patients get appointments? These are frequently asked questions in a value-based model.
Health plans provide some data to support practices in VBC, but it is often not actionable due to significant lags in claims processing, HEDIS calculation, etc.
Practices need sophisticated tools and analytics to translate the wealth of information at their fingertips into insights aligned with their value-based contracts – there is no substitute for real-time, actionable data to support providers and their staff in improving patient outcomes.
The Right Partner Makes All the Difference
The key to VBC success is the right technology platform. Find a partner that provides a user-friendly and comprehensive solution. Look for a plug-and-play solution that will unify your workflow, expertly track patient populations across payer contracts, proactively trigger alerts for wellness and chronic care visits, and provide seamless reporting of performance on contractual quality metrics.
Ultimately, VBC models empower providers to deliver an improved patient experience, while lowering cost of care and improving clinical outcomes with an emphasis on health equity. When executed effectively, the model works well and is a win for all: payers, providers, patients and communities, all driving population health.
Meaningful incentives and supporting technologies are out there. Do your research and partner with the right organization to get the most effective and efficient system in place, properly positioning your practice for success.
About Hugh Lytle
Hugh Lytle is founder and CEO of Equality Health, a VBC leader offering a comprehensive solution set including VBC contract participation, financial incentives, a unified technology platform, culturally competent care training and practice performance consulting to help independent PCPs be successful in VBC to drive quality and population health among underserved communities.
