Value-based care models have the potential to transform our healthcare system and how you practice medicine.
Foundational ideas on which the promise of value-based care rests include:
- Preventive care and chronic disease management
- Improved population health and better health outcomes across the practice spectrum
- Alternative payment models that reduce healthcare costs
- Improved patient satisfaction
Whether you've already shifted to a value-based primary care strategy or you're still considering how an alternative practice model might best serve your patients, you may wonder how you can keep your practice competitive.
Here are some value-based care trends to watch in 2022 and beyond, and some strategies you can implement in your practice.
The move toward value-based care by CMS
The Centers for Medicare & Medicaid Services (CMS) Innovation Center has set a strategic goal of moving all Medicare fee-for-service (FFS) beneficiaries and most Medicaid beneficiaries to accountable care by 2030.1
This broad initiative aims to pay for healthcare based on value to the patient instead of service volume — ultimately transforming the U.S. healthcare system. This shift from FFS to value-based care won't happen overnight, but this broad effort is sure to affect many primary care practices.
A greater focus on health equity
Value-based care trends include a strong focus on eliminating health disparities among traditionally underserved populations.2
Expect demographic information, along with information on the social determinants of health that influence how patients access and receive care (such as access to transportation and healthy food) to become a critical component of a value-based care transition for any primary care practice.
The COVID-19 pandemic further put health inequities in the spotlight, highlighting the need for accessible and equitable care among underserved populations.
Shifting care models to disease prevention and management of chronic conditions
Gone are the days of fee-based services for the sickest patients as a main practice income driver. Value-based care models shift the focus to preventing disease and managing chronic conditions over the lifespan to help keep patients well and reduce hospital readmissions. Financial incentives in value-based care models reward improved outcomes in these areas.3
Providers of value-based care models move away from fee-for-service thinking that focuses on adding more patients and providing more services.
In value-based care, providers focus on meeting identified patient care and outcomes benchmarks to achieve financial incentives.
These benchmarks may be related to:4
- Reducing the number of patients readmitted to the hospital
- Implementing technologies within the practice that improve the patient experience
- Using team-based care models to meet and anticipate the needs of patients with chronic conditions
Aligning around a patient-first focus
Value-based care models help improve health outcomes for patients by making sure they get the right care from the right provider at the right time.
But they also put patients at the center of care programs that offer add-on services like:5
- 24-hour support
- Transportation to appointments
- Preventive care plans
- Help understanding insurance benefits
Patient engagement becomes more important than ever to encourage lifestyle changes that help prevent or manage chronic conditions.
New ways of providing care — and new challenges
The COVID-19 pandemic required primary care practices to pivot quickly to new ways of providing care using telehealth tools and remote monitoring technologies. Many of these new tools are here to stay, offering improved patient engagement and more accessible care that helps eliminate disparities.
COVID-19 also caused supply chain disruptions and clinical team burnout that has rippled through the healthcare system. Value-based care models can help address these concerns by aligning supplier pricing and clinician efforts with improved health outcomes, particularly around avoiding and managing chronic disease.6
Provide care, perform exams and stay connected to your patients when you can't be face-to-face, with telehealth and virtual care. See solutions >
Prepare your practice for value-based care success
Implementing value-based primary care strategies can help your practice succeed in a model that rewards improved outcomes.
Consider these shifts to capture and analyze data, coordinate patient care and engage patients in monitoring and caring for their own health to position your practice for success:
1 | Invest in data technologies and experts
Succeeding in a value-based care model requires access to information. You need to not only know how individual patients are faring but how health outcomes are improving — or not improving — across your full patient population. You'll need to get ready to report this data to regulatory bodies, plan administrators and employers.
To meet these needs, invest in tools that allow you to capture quality data and aggregate it in a Health Insurance Portability and Accountability Act (HIPAA)-compliant way.
Additionally, collecting and analyzing de-identified health and quality data gives you the population health information you need to meet benchmarks and attain financial incentives. Comprehensive data collection and review also allows your practice to analyze how the costs of specific value-based initiatives compare to improvements in patient health outcomes.
2 | Have the right support team in place
Successful value-based care models require an integrated team approach. From data management to coordinating clinical care, each team member plays a critical role in achieving benchmarks in your practice.
You'll need trained experts to:
- Support provider relationships
- Coordinate patient care across provider teams
- Oversee patient outreach and adherence
- Manage documentation and coding for billing
3 | Build a patient care dream team
Building relationships with other healthcare providers helps create an integrated team to provide comprehensive patient care. Align your practice with specialists and give patients a choice of providers to visit.
Reaching out to community organizations is another important step in building comprehensive value-based programs that address social determinants of health.
Program examples include:
- Behavioral health and substance use counseling
- Healthy food access
- Safe spaces to exercise
Inviting community organizations to join your team strengthens your patient care network, while facilitating access to a full spectrum of care and services can help reduce health disparities for the patients in your practice.
4 | Focus on improving patient engagement strategies
Communication and patient engagement are critical to achieving the goals of value-based care. Implementing a value-based model begins with knowing your patient population:
- Assess individual patients to determine if they might benefit from a care management program for a chronic condition or preventive care program based on individual risk factors
- Look for opportunities to integrate care among providers to create a team-based approach. Offer care management programs for patients with chronic conditions to make sure they get the care they need and adhere to medication regimens. Nurse educators can play a critical role in coaching these patients
- Create preventive care programs designed to lower the risk of developing chronic conditions for at-risk patients
- Invest in tools and strategies that promote patient engagement. Automated tools that communicate with patients via text, phone call or email can help improve treatment adherence and patient satisfaction
Connect to patients wherever they are & help guide them on the path to better health with McKesson VerbalCare®. Learn more about VerbalCare >
5 | Encourage treatment adherence with at-home care
Invest in remote patient monitoring (RPM) tools to help you care for patients wherever they are. For example, McKesson Medical-Surgical offers telehealth and virtual care solutions to help you stay connected to patients and improve care for chronic conditions.
RPM tools give you seamless access to patient information that helps improve clinical decisions and treatment planning. For example, with RPM tools, you can monitor an at-home patient:
- Blood glucose
- Blood pressure
- Pulmonary function
With the automatic transfer of patient data, you and your team have access to real-time information whenever you need it. This access offers an advantage over single-point-in-time patient data, helping you stay informed about your patient's condition and their response to treatment between visits.
A 2021 review suggests that remote monitoring can even lessen the need for acute care in patients with cardiovascular disease and chronic obstructive pulmonary disease (COPD).7
6 | Stay focused on the metrics
Value-based care is all about outcomes, so metrics matter.8 Evidence not only helps you see how you've met the goals you set for your practice, but it also helps you set new goals to improve patient health.
Implement standardized methods for gathering data on:
- Patient treatment adherence
- Patient engagement and satisfaction
- Hospital readmissions and emergency department care
You can also take advantage of improved cost and health outcomes data transparency to see how your practice stacks up. Regularly benchmark your practice against peer practices to identify opportunities for improvement.
As more primary care practices shift to value-based care models, it's important to remember these models are a work in progress. As you analyze data from your practice's value-based efforts, know that you can continuously realign your primary care strategies to get the best health outcomes for your patients at a lower overall cost.
All trademarks and registered trademarks are the property of their respective owners.
© 2022 McKesson Medical-Surgical Inc.