The healthcare industry is in the midst of a challenging transition to value-based care. Many expected the change to happen more quickly. Yet payers, especially large ones like Cigna and Aetna, remain committed to value-based care, and hospitals and physician organizations are inching towards taking on more risk. Nevertheless, the payment model is expected to account for 59 percent of healthcare payments by 2020.
At Geneia, we work closely with health plans, hospitals and physicians evolving to value-based care. In the course of our work, we have discovered that the most successful organizations are using some or all of these best practices.
Best Practices for Transitioning to Value-Based Care
- Employee Experimentation: Your employees can be an incubator and learning lab for innovation. Healthcare organizations often are large employers. Hospitals, for example, are the largest employers in 16 states. Most large employers self-insure employee health benefits, meaning they have the flexibility to experiment to improve engagement, chronic illness management and especially wellness efforts.
Research suggests employer wellness programs have had little impact at the population level yet we know the way to combat the prediabetes epidemic is by engaging employees in exercise and better food choices, making this area one that is ripe for innovation and experimentation. Successful innovations can then be deployed to patient populations.
- Employer Partnerships: Hospitals and physician organizations are partnering with employers in the community. With health costs projected to increase another five percent in 2020, large employers are keenly interested in more closely aligning themselves with healthcare systems to improve access to primary care, virtual care and more.
The practice of direct contracting between hospitals and employers has gained steam. According the National Business Group on Health, nearly half of its members either are already directly contracting with providers or planned to do so in 2019. Nearly a third of employers plan to implement an accountable care organization (ACO) and/or high-performance networks, and that percentage could nearly double to 60 percent by 2022.
- Patient Relationship Management (PRM): Surround the patient in engagement and use technology to share patient information with all healthcare stakeholders. As Geneia’s head of product management wrote in a blog, healthcare needs to leverage the best of retail and CRM (customer relationship management) techniques to better understand patients and personalize engagement:
“I imagine a future in which a CRM approach is taken with every patient, whereby the essential historical views are available to the right caregiver, and a patient’s level of risk (healthy, rising, chronic or catastrophic) and social needs (socioeconomic, transportation, healthy food, mental health) are used to direct the patient to the ideal location for services whether that’s a physician office, a retail pharmacy, urgent care center or even the home in the case telemedicine and remote patient monitoring.”
- Physician Misery: Physician burnout is potentially as deadly as the diabetes epidemic and every healthcare organization has a role to play in improving physician satisfaction. Physicians and other clinicians are the heart of value-based care yet Geneia’s national survey found:
- 80 percent of physicians say they are personally at risk for burnout at some point in their career
- Nearly all surveyed doctors (96 percent) report they have personally witnessed or personally experienced negative impacts as a result of physician burnout.
Savvy healthcare organizations are committing to reducing commonly-accepted physician frustrations such as improving EHR workflows, identifying and mitigating patient social determinants of health (SDoH), wearing the Joy of Medicine pin, and more.
- Clinical Integration: Payer provider clinical integration enables access and exchange of care management data such as SDoH within the EHR as well as clinical quality and admissions, discharges and transfers (ADT) for transitional care management. As I’ve written before, today’s world of isolated EHRs and health information exchanges (HIEs) was not designed to handle collaborative patient care across care teams, especially where care teams span multiple health systems. Healthcare organizations hoping to achieve value-based care success need to look beyond the EHR to solutions offering a tier of patient data enrichment, modeling, scalability and decision support that can be integrated into the clinical workflow and shared across every cost and care setting.
Undoubtedly, the healthcare industry is making progress in achieving the goals of value-based care. A Change Healthcare study earlier this year found, “48 states have now implemented value-base care or payment programs, 50 percent of those programs are multi-payer in scope, and just four states have little or no value-based care initiatives underway.” Nonetheless, more needs to be done to fully engage patients, physicians, hospitals and employers in value-based care in the way payers are.