The concept of value-based care is no longer new; but the current repeal-and-replace debate, combined with the implementation of a major new payment methodology (MACRA) has propelled cost and quality issues to center stage. US healthcare delivery is in a transition period where finding ways to effectively reach value-based goals will be key for all stakeholders.
Here, Cindy Buckels, of TAVHealth, an organization that helps providers transition patients from hospital to home by solving for Social Determinants of Health via a cloud-based platform, outlines the two competencies critical to success in today’s value-based market.
Over the past several years, CMS has increased incentives for higher quality care at lower costs and providers are transitioning from fee-for-service methodologies to value-based care. No longer reimbursed and incentivized by the amount of services rendered, providers will be reimbursed and incentivized by the quality of their overall outcomes.
This new version of healthcare will require providers to go beyond traditional thought processes and standards and collaborate with a patient’s entire care team. To effectively navigate bundled payments and optimize fee schedules, providers must construct a framework for risk management and improved care coordination. These core competencies are at the heart of a successful transition to value-based care.
Providers who better manage their potential risks will better manage their outcomes. It stands to reason that there will always be variables that are beyond the provider’s reach. However, there are many opportunities for providers to reduce risk factors—many of them right beneath their noses and well within their control. For example, research shows that prolonged urinary catheter use is the leading risk factor for catheter-associated urinary tract infections. Based on this information, one client implemented a risk management plan requiring physicians to regularly evaluate the catheter. The end result was a decrease in patient risk, which led to improved overall patient outcomes.
Reducing in-house episodic patient events like these is the first step in effective risk management strategy. Hospitals and healthcare organizations each face unique challenges and there is no one-size-fits-all solution. However, investing time and resources into strategies to reduce risk will result in more effective care with improved patient outcomes.
Though it remains uncertain as to whether or not the Trump administration will continue the practice of bundled payments, for now they are in place. These payment models demand accountability for care across the continuum. Providers must be able to collaborate and communicate with a patient’s entire healthcare team. Hospitals must implement systems that prevent the isolation of silos and encourage transparent communication.
Connectivity is the key, and many providers are discovering that EMRs don’t quite get the job done. Opening up the lines of communication is critically important as providers participate in these innovative care models. For example, when patient records are not consistently updated and shared, there can be a breakdown in communication resulting in error, duplicative services, and wasted resources.
One TAVHealth client, a cardiac surgery practice, recognized its staff was isolated and communication was not fluid with the hospital and other providers. The hospital, meanwhile, was concerned about its readmission rates, particularly with cardiac surgery patients. The implementation of a system to communicate with their patients following discharge from the hospital resulted in staff learning the barriers to health that their patients were experiencing, such as social, financial and psychological factors. Understanding the social challenges some patients faced help staff customize outreach and follow-up care, and that helped to reduce readmission rates and increase overall outcomes.
Paying attention to life outside the clinic and hospital walls is what we do at TAVHealth. We understand that acknowledging and managing the social determinates of health (that is, the conditions in which people are born, grow, live, work and age) is key to success in the value-based world. Too often, providers are unaware of the hurdles patients face as they transition out of the hospital or clinic (no transportation, can't afford medications, social isolations). These circumstances can derail even the best care plans. Our workflow and sharing tool creates coordination and accountability for everyone involved in a person's journey back to health.
Healthcare Version 2017 and Beyond
There are many challenges within the healthcare arena and new uncertainties as the Trump administration begins to make its mark on the system. Healthcare Version 2017 will see providers focused on improving patient outcomes and reducing costs in innovative and more collaborative ways. For patient, payer, and providers, that equates to a major win.