Value-Based Care—The Future of Health Care: Part 1 of 2

Value-based care creates a new paradigm—one in which care is no longer delivered only by doctors and nurses, but by an entire community of providers that treat the “whole” patient rather than just treating the disease. Communication and care plans can no longer live inside the four walls of a doctor’s office, but must integrate information from the community to fully address the needs of the patient and of the population. Further, those members of a patient’s care team must work together to deliver an effective and coordinated treatment experience. This blog—part 1 of a 2-part series—introduces the idea of value-based care, and discusses how integrating care coordination with robust analytics into a single platform provides the big picture of patient care, enabling efficient, collaborative care for diverse teams to treat complex populations. Part 1 is an introduction, intended for those starting to explore the idea of value-based care. Stay tuned for Part 2, which will be a deeper dive into some of the key issues facing the industry.

Value-based care is not a new idea—it is simply the term du jour for a model in which providers are paid for keeping patients well (fee-for-value), not for the number of services they perform (fee-for-service).

In a fee-for-service model, providers are incentivized to do more procedures—and therefore have little incentive to deliver efficient care or prevent unnecessary care. In this model, it is up to the payer to police the procedures that are approved, which can create disputes between providers and payers about what is viewed as medically necessary and which “experts” make the call.

In contrast, fee-for-value models offer payment based on keeping a patient well, encouraging improvement by emphasizing the outcomes of care and incentivizing providers to improve efficiency—in other words, delivering value rather than delivering fees.

Over time, major public payers such as Medicaid and Medicare have put significant energy into driving value-based payments, creating innovative approaches that use integrated care teams to treat the chronically ill. As possibly the largest new program, New York’s Delivery System Reform Incentive Payment (DSRIP) initiative targets a 25 percent reduction in readmissions, and is one of the most ambitious and far-reaching value-based program being implemented today. The DSRIP model continues to evolve, and is being implemented beyond New York to broadly reform and bend the cost curve of healthcare for Medicaid patients nationally.

As value-based models have continued to evolve, we’re seeing a new level of care—delivered by entire communities who “touch” the patient, rather than just by the doctors and nurses overseeing their medical care. Community-based care is especially important for patients with chronic diseases and comorbid conditions, because these patients are the costliest to treat. It truly “takes a village” to treat these patients—multiple types of providers, including an entire range of social services in addition to medical and behavior health, must come together to make sure the entirety of a patient’s needs is addressed and to bring about better health outcomes. This means that communication and care plans no longer live within the four walls of a doctor’s office or hospital.

This change is a positive step for the health industry, but the question is how to do it. There is no single mandate or tool set that must be used to achieve this objective, but the industry is migrating to a de facto set of standards and operational norms for collaboration, care management, population identification and stratification, and secure data aggregation.

Stay tuned for the next edition of the blog for a more detailed discussion about these standards, including how to use technology to collaborate with a community of interdisciplinary care givers, manage to the big picture of patient and population health, and stratify and assess risk so you can intervene with “rising risk” patients before they become high risk—all while protecting the security of patient data.

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