VBC is Not a Do-It-Yourself Proposition

This article is one in a series that advocates the need to bring specialty care under value-based care payment models. Click here to read the previous article, Factoring in Social Determinants of Health (SDOH): A Value-Based Care Imperative.

Why haven’t more providers and payers taken the VBC plunge? Despite evidence that value-based care works, adoption isn’t where it should be. Why? Simply put, realizing the benefits of VBC is daunting. It takes a host of players, interwoven processes, and technology—plus new ways of thinking—to put VBC in place and make it work.

The concept of incenting health outcomes rather than paying for volume of services provided isn’t new. It was introduced in 1967 by the American Academy of Pediatrics, followed closely by adoption by HMOs and managed-care organizations. The National Academy of Medicine, the Medicare Modernization Act, the Affordable Healthcare Act (ACA), and Accountable Care Organizations (ACOs) have also pushed VBC forward over time in response to increasing recognition of the limits of traditional fee-for-service payment models.

Fundamentally, industry insiders, regulators, care providers (and patients) understand that paying for healthcare based on volume of services provided isn’t sustainable, while paying for healthcare based on outcomes, is. The question now; what needs to happen for VBC to become more widely embraced?

To successfully operationalize value-based care, 10 strategic tenants must be achieved:

1. Put a Change Management Mindset in Place. Create an atmosphere that truly promotes the changes necessary to transition from historical fee-for-service to value-based care.
2. Create A Truly Patient-Centered Culture. With a focus on better patient care, the cornerstone of value-based care, the entire ecosystem improves through the efficiency, connectivity, and alignment of all audiences —payer, provider, and patient.
3. Use Analytics to Drive Healthcare Decisions. To solve the complexities of value-based care, deploy platforms that integrate payer and provider data, enabling in-depth insights into Specialist performance, healthcare cost, and quality care.
4. Integrate Specialized Teams. Alignment of typically disconnected groups makes it possible to gain meaningful insights and set strategies surrounding economics, provider connectivity, and improved patient journey.
5. Integrate Technology, Optimize Workflows. Implement technology solutions that ensure the transformation of data into actionable insights and make data the foundation of truly integrated patient care through all platforms.
6. Engage Providers to Define New Best Practices. Create a collaborative environment that incorporates the best practices and insights of primary care physicians and Specialists.
7. Instill Best Practices Throughout All Care Pathways. Within each specialty and episode, create a patient journey that is streamlined and ensures the right course of action for each patient because all activities are guided by data-driven insights.
8. Establish Benchmarks, Measure Performance. Successful value-based programs begin with clearly identified quality and cost metrics that serve as the foundation from which to measure success and improvement.
9. Drive Compliance Across All Participants. Build programs that educate, drive commitment, and support active engagement of all audiences in value-based programs.
10. Continuously Improve. Create an environment that is constantly analyzing provider performance, payer-provider financial alignment, and most importantly, quality of care, because quality-driven patient care drives savings throughout the entire ecosystem.

While many payers and providers believe in the promise of value-based care (VBC), most don’t understand how to realize its benefit. Healthcare leaders that work with an experienced VBC partner to guide the transition to a more sustainable future stand to achieve better results faster—and to become the leaders others in the industry follow.

This article is one in a series that advocates the need to bring specialty care under value-based care payment models. Click here to read the next article, All Participants Must Come Together to Deliver the Promise of Value-Based Care.

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What is the history of value-based care?