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Keeping an Eye on Value-Based Care – 3 Things to Watch


“Work smarter, not harder.” This age-old philosophy is the mantra behind value-based health care. After all, more health care doesn’t necessarily mean better outcomes – this much has been proven by evidence-based medicine time and again. As the fee-for-service model of health care slowly fades away, true value-based care (and all the benefits that come with it) is finally becoming a reality. Better coordination of patient care, communicating with patients, decreasing unnecessary and/or duplicate services – and incentivizing those who truly improve care (and not just those who deliver more) is happening across the country as health systems and providers shift models of care while desperately trying to preserve their reimbursement.

The latest trends in value-based are showing real movement as we finally have enough data on the effectiveness of episode of care models, bundled payments and all that comes with the shift to payment reform in healthcare. Here’s some of the top trends to keep an eye on as health care organizations strive to change the way they’ve delivered care for decades.

1.) Proof of concept is there, but what’s next? According to a 2018 research study commissioned by Change Healthcare, value-based care is reducing unnecessary costs for payers by an average of 5.6% – with 25% achieving savings of 7.5% or greater. The same study indicates that 80% of payers reported improvements in quality of care, 73% reported improvements in patient satisfaction and 64% reported provider relationship improvements. Across the country, payers and accountable care organizations (ACOs) alike are reporting millions of dollars in annual savings by adopting value-based models of care. Now that the concept of value-based care is gaining traction, healthcare organizations will need to continue to innovate and use data to identify what areas can make the greatest impact in terms of both quality and value for all parties involved.

2.) Providers aren’t fully on board. Across the country, physicians are burned out and this monumental shift isn’t helping. One challenge noted in numerous studies is physician engagement – which is critical to the adoption of value-based care. A 2018 New England Journal of Medicine (NEJM) Catalyst survey indicated that only 38% of clinicians thought value-based care would improve quality of care. Similarly, only 36% believed it would have the ability to lower costs. Another survey of 3,400 physicians revealed that 61% of providers actually believe the shift to value-based care will have a negative impact on their practice. Yikes. Organizations that are going to be successful in this critical shift will have to find innovative ways to engage with and prove value to this discerning audience.

3.) It’s not all savings, yet. You have to spend money to make money, right? Well, as it turns out, you have to spend money to save money, too. Episode of care models and value-based patient care programs are labor-intensive – both to develop and to manage. Research shows that the administrative side of managing the delivery and the payment side of these programs is requiring more administrative staff. Similarly, the need for data and analytics to support value-based decision-making is critical – and studies indicate that many payers and value-based providers are unhappy with their current analytics, automation and reporting tools. Investing in the right people, tools and technology can make all the difference in an organization’s ability to achieve the triple aim of value-based care. These up-front investments can be staggering but should pay off in the long-run for those truly committed to the cause.

With increasing pressure to reduce our nation’s health care spending, all eyes are on providers, payers and health care executives to deliver the triple aim of value-based care – better value, greater quality and more satisfied patients. While value-based care isn’t happening overnight, it is happening – and more quickly than some expected. If you’re not already, now’s the time to get on board.

GeBBS Healthcare has decades of expertise in revenue cycle management and coding – and can help organizations of all sizes prepare for the inevitable shift to value-based reimbursement.

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