Transitioning to Value-Based Care: 7 Smart Practices

The healthcare space is in the process of a challenging transition to value-based care. The expectation that most organizations can make the transition in a year or two is overly optimistic. Complete transformation may take a long journey and will require careful consideration. So far, we are witnessing good progress and can expect even greater advancement in the future. Aetna estimates that the payment model is expected to account for 59 percent of all healthcare payments by 2020.

The U.S. healthcare industry continues to grow towards value-based care, leaving fee-for-service behind. For the past eight years, the number of U.S states that are in some stage implementing value-based care programs has increased to 48 states in 2018, up from just three in 2011. The introduction of value-based care means that agencies and clinicians will be paid based on patient health outcomes instead of fee-for-service healthcare.

This new transition has executives reassessing just about every aspect of business operations, from staffing to IT and other infrastructure. The new reform could help reduce costs while driving the need to achieve better healthcare. It means that healthcare professionals must play by a new set of rules and be up to speed with the best practices to ensure they make strategic adjustments on time.

As behavioral health moves towards value-based payment, EHRs will be among the tools that must be exceptional in order to accommodate the changes in treatment planning and payments. Value-based care will need a greater share of good care that must be consistent, and specialty-specific EHRs will be essential to oversee the development of a consistent measurement process. In the end, it’s about achieving improved care at a reduced cost to boost patient satisfaction–all at the same time.

7 Steps for Transitioning to Value-Based Care

1. Timing is Everything
The transition to value-based care continues to gain momentum, however, there is little to no consistency in the rate at which it’s being adopted across markets or providers. To achieve success under a value-based care system, providers must take action to reduce fee-for-service payments. While this can be a great solution for many businesses, it may hasten the transition process and even subject the healthcare facility to the risk of financial stability.

Waiting too long to make the right investments, however, exposes the facility to the same risk, so timing is everything, and varies in every market. Decisions on how and when to make the move to adopt these strategies depend on factors such as government policy drivers, local and regional market drivers, and the company’s strategic intention to adopt the new care models.

Federal and state initiatives provide a consistent floor for the transition to value-based reimbursement by pushing for lower reimbursement rates and more effective management. At the local level, the pace of change is determined by the population size, market costs, employer health plans, payer activity, and competitors. Once you understand the external market drivers, it’s important to focus on the organization’s current profile, including its history, culture and leadership. Simply put, stakeholders must have a clear understanding of where the organization stands. Once this is clear, the next thing to focus on is how the organization wants to be positioned in the future with regard to adopting value-based models. This includes the pace of change required to achieve the complete transition.

2. Know Your Client Population
Do you know who your patients are? Their background, demographics, health histories, insurance plan, and so on? Even when you get this information right, you need to figure out what data is important, what can be collected easily, what data points match the patient population, and if this information allows for precise measurement. All these factors affect how an organization delivers care, especially value-based care.

To effectively manage clients across a vast spectrum, you need a plethora of data assets such as structured EHR data elements, information about the patients under your care, and paid claims details. There is a lot of information available to you when you deploy an electronic health record to help keep the details in check for every patient. With an EHR in place, you can analyze patient population data to reveal previously unseen patterns that will help you make the right decision when it comes to treatment and services.

3. Invest in Staffing
To provide high-quality care to every client you see and treat, you need a team of qualified individuals. This requires substantial investment in your staff. Remember new healthcare roles, workflows and additional touchpoints for patients are likely to come with the value-based model. These demands require a dedicated team to address issues such as transitioning patient care, managing patient cases, and improving the quality of care.

Using an EHR designed specifically for behavioral health can help you better coordinate inpatient assessments and identify if the care plan is working. It will also help you measure the patient’s ability to function in the community. A proper technology system can help you save money you would typically spend on administrative personnel, allowing you to use those funds to hire new clinicians or explore other revenue generating activities at your agency.

4. Form Partnerships with Related Organizations
The healthcare industry intends for value-based care to significantly improve the quality of care and reduce costs. However, the transition has caused serious challenges, especially for independent practices, which has precipitated the need to find new options by partnering with related organizations.

For instance, if you have a large pool of at-risk patients, they might find it hard to make frequent visits or keep their appointments due to inadequate or reliable transportation. Partner with a local organization that can provide free or pocket-friendly rides to the facility. This approach helps you cut costs without sacrificing quality care.

Organizations related to your field have the ability, scale and finance to quickly implement alternative strategies, payment models and even absorb financial risk. Make sure you are working with them.

5. Create and Launch Your Care Model
It’s vital to create evidence-based care models that are easy to implement with your team. Pre-plan and put flexible workflows in place that provide the desired care to your target population. Specify the roles and responsibilities of everyone and identify measurable success metrics to get a clear picture of what to expect in the future. Then, it’s time to roll out the new care model.

Make sure you have reliable structures in place to tackle any form of disruptions to critical systems to safeguard the user’s interest. During the adoption process, you may discover that the model is not perfect. Don’t panic–trial and error is an expected result of change. Instead, seek help from financial experts and analytics tools to identify the actual patterns of high-cost spending including any unnecessary charges associated with your organization.

6. Deliver Quality: There is No Other Way
You’ve probably heard that “quality is king”, and that concept is critical to providing meaningful behavioral healthcare. As opposed to fee-for-service, value-based reimbursement defines payment in terms of quality rather than quantity. Healthcare organizations are expected to demonstrate quality improvement year after year. Unfortunately, many organizations still find themselves in the earliest stages of adoption when it comes to quality measurement. That’s where a robust EHR can help. Let the system’s reports and dashboards work for you–follow trends and see where you can make improvements to your clinical and financial outcomes.

Providers must strive to ensure that the decisions they make are aimed at achieving gains throughout their participation in risk-based arrangements with payers throughout their contract. Quality measurement should also provide the right information and direct you on the right path to make any necessary corrections, or continue to be consistent in delivering quality and effective care.

7. Evaluate How You Measure Success
How can you say that your organization has successfully adopted value-based care? You need to put a system in place to measure success. The key elements that show you’re on your way to success include identifying opportunities and gaps after an assessment, and designing better care models that lower costs and support better health outcomes. It’s important to consider organizing network governance to guide clinicians and enable a practical transformation with the right tools.

Communication between your employees and clients is of vital importance. Part of your design care model should include how often you communicate to your team on a platform that can be integrated with your electronic health record system. And pay close attention to how often clients come to your facility for care. If they are pleased with their progress, they’ll keep coming back.

Closing Thoughts
Value-based healthcare will have a significant impact on the way the entire healthcare industry is run. Your medical organization needs to stay informed about emerging issues in behavioral health. A successful transition will rely heavily on the right strategies and the right technology. To navigate the transition successfully, make sure you are using an EHR that promotes collaboration, facilitates analytical reporting, and integrates seamlessly with other programs to provide exceptional care. Are you ready?

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