What areas should payers and providers focus on when contracting through a value-based care payment strategy? In order to succeed in value-based care payment models, insurers and practitioners may need to focus on population health management, clinical decision support tools, care coordination, and medication adherence programs. Below we outline these four entities more closely.
Population health management
Population health management is critical to succeed in value-based care payment and lower medical costs. The Academy Huron Institute released a report last year discussing how strengthening population health management will be imperative as more providers transition away from fee-for-service payments. Through population health strategies, providers and payers could improve patient outcomes and reduce hospital admission rates, which would reduce costs.
The report outlined how more healthcare organizations are putting their funds toward population health management and patient engagement in the form of implementing portals. With value-based care payment models aimed at improving patient outcomes and reducing costs, population health management will remain imperative due to its focus on disease prevention and management of chronic conditions.
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Clinical decision support tools
Health IT and clinical decision support tools have been moving into the healthcare industry in recent years. Payers participating in value-based care payment models may consider partnering with providers that have extensive experience in technology implementation. Clinical decision support tools have shown to support doctors operating value-based care payment programs, said Ryan Lee, MD, MBA, Director of MRI, Director of Quality and Section Chief of Neuroradiology, in the Department of Radiology at Einstein Healthcare Network.
“I think clinical decision support is that much more important in the value-based model because it eliminates waste,” Lee explained in an interview last year. “In the value-based model, waste is of high importance to eliminate. Clinical decision support allows a clinician to order the right test at the right time to minimize the wrong tests being ordered, and potentially even unnecessary tests.”
“I don’t think clinical decision support is leading us down the path of the value-based model. I think that path is already being steered toward the way legislation is being written, but it does help eliminate waste,” concluded Lee.
Strong care coordination across multiple specialties along with primary care physician offices and hospital systems is imperative for a successful value-based care payment strategy. Steven Strongwater, MD, President and CEO of Atrius Health spoke at Xtelligent Media’s Value-Based Care Summit this past November and described how a value-based care strategy will need effective coordination throughout skilled nursing facilities, at-home care visits, and end-of-life services.
In order to succeed in alternative payment models, Atrius Health partnered with skilled nursing facilities that have met high quality metrics.
“What we effectively did was that we vetted skilled nursing facility experts inside those skilled nursing facilities,” said Strongwater. “These are typically nurse practitioners that cared for people in the skilled nursing facility and when you have these providers imbedded in that facility you can see that the length of stay is lower by 14 days typically versus 30 days.”
“So, we cut that metric almost in half and the readmission rate, which was in the 25 percent range, was down to 8 percent,” added Strongwater. “And for us, a two-day length of stay reduction is worth about $2 million. So, it was a great investment for us.”
In order to improve care quality metrics and lower costs in a value-based care payment model, payers and providers will need to improve medication adherence among their patient base. For example, when the University of Pittsburgh Medical Center partnered with the Centers for Medicare & Medicaid Services through the RAVEN initiative, the organizations targeted medication adherence and pharmacy engagement tools to reduce avoidable hospitalizations.
By implementing population health management, medication adherence programs, clinical decision support tools, and care coordination strategies, payers and providers should be able to succeed in a value-based care payment model.
Date: December 30, 2016