Successfully implementing a value-based care (VBC) payment model can be complicated. And it is particularly difficult for smaller or independent practices to do alone.
The traditional fee-for-service system has succeeded based on the quantity of services provided. However, in VBC, reimbursements and incentives are based on the quality of care provided.
Long-term data can be instrumental in revealing where practices can make improvements in order to have success in VBC. However, this information is frequently complex and unclear, creating obstacles for providers looking to adopt the VBC payment model.
Fortunately, practices can overcome these challenges. Having a strong partner that can analyze the data and determine how to leverage it can lead to better population health, higher quality of care, and more effective care management. As a result, practices implementing VBC can experience a greater return on investment (ROI).
VBC is a less straightforward payment model than fee-for-service, but adoption is growing among providers. In fact, in 2020, more than 60% of payments received were linked to value. The Center for Medicare & Medicaid Services (CMS) created accountable care organization (ACO) models to help even more providers transition to VBC reimbursement. The pivot toward VBC has been so significant that CMS set a goal for all Medicare recipients to be part of an ACO by 2030.
Providers looking to shift to a VBC model understand that data is king. But such a payment system will only work if practices know what to do with that information and how to leverage it to drive significant improvements. The same is true for succeeding with value-based contracts — agreements that focus on delivering the best patient outcome for the lowest possible price.
To gather this data, providers take several steps:
With this data, practices can boost ROI in several ways when participating in value-based contracts. They can:
However, managing the data to achieve this ROI isn’t always easy.
Despite being a vital component to VBC, data presents several significant hurdles, says Joe Logan, chief information officer for Innovista Health Solutions. For example, when processing data to fulfill VBC requirements, providers can face these problems:
Providers already have enough to juggle every day, Logan says. But even if they’re equipped to process all the data, it can be overwhelming and interfere with patient care.
“They may think they understand their data completely,” he says. “But I would argue there are too many challenges for all providers to handle it all the time.”
Some practices may choose to tackle data analytics on their own. But collaborating with a partner who can focus on the insights can set providers up for not only better patient care, but greater ROI as they adopt the VBC model.
“The challenge for any particular office is the heavy investment needed to deal with growing a cohort or population, person by person, within a practice,” Logan says. “For many practices, that can be a scalability problem. Allowing a partner to manage all that data at a larger scale gives the office a way to manage and grow their business effectively.”
There are several benefits to working with a business intelligence (BI) partner:
“With a partner, practices can focus on the patients, not the data. And they stay compliant with their contractual relationships with payers,” Logan says. “They can realize a return on investment and focus on patient outcomes because someone else is helping to interpret the data.”
When done correctly, implementing a VBC model fosters a more patient-focused, collaborative environment. Practices can shift away from the existing heavy workloads typically found in fee-for-service systems. And by working with a business intelligence partner to properly use and analyze data, the transition to VBC becomes less cumbersome for providers so that instead, they can concentrate on their top priority: delivering quality care that offers more value to both patients and providers.