9 best practices for value-based care success

My current thoughts about value-based care can be boiled down to two core ideas –

1. The tools, data and analytics needed for value-based care are foundational to good healthcare.
2. As the direct result of the COVID-19 pandemic, we will see more value-based care.

Let me start with #2. The COVID-19 pandemic has taken a toll on physician finances. Primary care practices are on track to lose more than $67,000 in revenue per physician this year. A mid-September Primary Care Collaborative survey of primary care clinicians found:

• Only 20 percent of surveyed clinicians reported their fee-for-service volume is within 10 percent of pre-pandemic levels.
• “Nearly half (47 percent) agreed with the statement that despite a somewhat rosier economic picture, their clinical workforce is fragile.”

On the other hand, value-based care, and in particular capitation, provide a more repeatable, reliable revenue stream so physician practices can stay viable in times of uncertainty. It also allows providers to put their focus on patient care rather than creating a business plan and growing their business.

During the pandemic, many health plans have offered financial assistance to physicians in exchange for participation in the insurer’s value-based care programs. With COVID, there are providers who are feeling the pain of fee-for-service reimbursement for the first time.

Blue Cross and Blue Shield of North Carolina, for example, recognized that many independent practices were at risk because of COVID-19. They created a program, Accelerate to Value, to provide financial viability to these practices while moving to value-based care. More than 400 practices signed up.

Many health plans have announced new value-based care contracts and programs during the pandemic. Headlines from the past few months include:

• Blue Cross Blue Shield of Massachusetts

  Blue Cross Blue Shield of Massachusetts Pilots New Value-Based Payment Program For Independent Primary Care Practices

• Blue Cross Blue Shield of Minnesota

  BCBS of Minnesota adds 47 primary care clinics to value-based platform

• CareFirst

  CareFirst, MedStart Look to Lower Care Costs by $400M in New Value-Based Care Partnership

• Humana

  Humana Launches Two More Value-Based Programs for Specialty Care

Even Walmart Health has jumped into the mix with its Oak Street Health partnership. “As we grow Walmart Health locations in other markets, we think Oak Street Health’s innovative value-based healthcare model will help us continue to deliver on our live better promise at these locations.”

Value-Based Care Best Practices

As I emphasized on a recent episode of the Geneia podcast, the tools, data and analytics needed for value-based care are foundational to good healthcare. The crux of value-based care is to provide the right care at the right time in the right setting, and being compensated for that care. Without a doubt, data analytics and tools are needed to make that happen. Payer provider collaboration is critical too.

As more providers and health plans embark on new value-based care contracts, I would like to share some of the best practices I’ve learned, sometimes the hard way, in the past 10 years.

1. It’s all about the relationship. Focus on it. Nurture it.
2. Truly respect each other’s roles.
3. Create the partnership from the person’s perspective as well as the financial and business perspective.
4. Empathize and understand goals and constraints.
5. Be willing to bend a little.
6. Use the COVID-19 pandemic as a time to build trust and collaboration.
7. Start small. Pilot new programs.
8. Identify small wins to get started and build common ground. Start with a specific initiative. Success breeds success so celebrate success.
9. Enable shared decision-making. For example, if there are opportunities for improvement within the patient population, let the clinical team on the provider side decide where to start.

To learn more, listen to Geneia Conversations: Value-Based Care & COVID-19.