Dr. Suneet Singh Discusses Value-Based Care and Alternative Payment Models

Dr. Suneet Singh Discusses Value-Based Care and Alternative Payment Models

Change is the only constant we have in life.    

Without change, health care as we know it would not exist. Changing the way we think about health care today ensures a better health care system for all tomorrow.  

Even if all signs point to better outcomes than the ones we see today, there’s this powerful urge to fight against the change. 

We see this phenomenon play out in health care once again, but it’s not connected to research or a new therapeutic approach. The latest change on the horizon – Value-Based Care and other alternative payment models – can be a potential game-changer for the industry.  

Why resist value-based care and alternative payment models?

One explanation may be the inherent challenges faced when moving from the more familiar fee-for-service model of care. Providers have become accustomed to – and therefore commonly cite – the idea of “the risk of financial loss” as the most significant barrier to moving to an alternative payment model. In today’s healthcare system, it is easier to model revenue streams with fee-for-service care than it currently is for value-based care. The risk of financial uncertainty can be too significant a fear to overcome for some providers.

Another explanation comes down to a simple lack of resources within a practice. Integrating and sharing data between different systems seamlessly is an essential factor for success with alternative payment models; it’s both expensive and time-intensive to create the infrastructure needed for value-based care analytics and data exchange. There are additional labor costs to appropriately staff for care delivered under alternative payment models.

Yet another reason for barriers is the current fragmented healthcare delivery system. Each system member has to align on desired clinical and financial outcomes while operating with appropriate efficiency to protect business goals. This complexity requires a high degree of cooperation amongst providers and payers to succeed.

How do we overcome the resistance and adopt alternative payment methods?

1. Stabilized regulatory and political policies: Although Value-Based Care rewards providers for delivering effective care at lower costs, overall practice revenues are still heavily slanted towards the fee-for-service model of care. Additionally, government policies and regulations continue to be in constant flux, leaving providers in the value-based care space facing the continuous challenge of keeping up with various operational changes across the different programs.

2. Creating systems to share data across healthcare practices. Successfully implementing value-based care depends on the adequate collection, analysis, and sharing of data. Measuring performance and adequately assessing the value being created at the individual or population level can be impossible without any of these elements. From a care delivery standpoint, lack of data availability leads to the current state of fragmented healthcare – a system rampant with waste due to poor care coordination.

3. Introducing a variety of provider costs to improve the alternative payment method system. Successfully implementing value-based care requires a healthcare team composed of providers, nurses, social workers, case managers, and ancillary staff members. Creating value by delivering proactive measures means clinical workflows need to be revised from those in place in more customary fee-for-service healthcare delivery models. Though these changes are not directly accounted for in today’s alternative payment method systems, data gathering is inherent within the value-based care framework. It is in a unique position to collect staffing and service-level data for their consideration of incorporation into future payment arrangements. Currently gathered from patient-reported measures, the direct measurement of the use of different providers and how it affects clinical outcomes could one day be incorporated into a Condition-Based Payment model – perhaps into a new type of alternative payment method altogether.

Get past the reluctance and put value-based care into play.

Patient Satisfaction is vital. From the patient perspective, the key to success in value-based care is the quality derived from measuring outcomes that matter most to their experience. Patient responses gathered from health plan surveys that are part of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program are directly integrated into value-based care reimbursement models. Without adequate patient buy-in, healthcare professionals might find themselves in situations where they believe they have created maximal value for the patient. Still, the patient satisfaction assessment scores might show otherwise. In cases like this, reimbursement will not be optimal. However, the positive side is that it will reflect opportunities to improve patient-provider communication, patient safety, and patient education initiatives.

Keys to making value-based care models successful. When driving greater adoption of value-based care, it’s essential to reduce the number of alternative payment models. The overall model should create alignment across the alternative payment methods by focusing on how each can function in the greater context to reduce spending and increase quality. Overall success will be decided when providers have more significant incentives to embrace these models.

 One incentive method is having alternative payment models share both short and long-term savings with providers. This allows for the development of new clinical workflows, protocols, and initiatives that live in value-based care service.

From here, providers are in a better position to achieve success through meaningful practice transformation that embraces data science and population health management, leading to overall improved care for our patients. It is this very model that CareHive is built upon.

Suneet Singh, MD, FACEP // Medical Director, CareHive // Assistant Professor of Surgery & Perioperative Care, University of Texas at Austin Dell Medical School

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