The move toward value-based care continues to intensify. Some research estimates one in five Americans will be part of a value-based model by 2025. The largest growth, however, will be among the Medicare population. The Centers for Medicare & Medicaid Services (CMS) requires that all Medicare beneficiaries be enrolled in a value-based model by 2030.
With value-based care projected to grow to this extent, now is the time for providers—especially those in primary care—to consider making the switch from fee-for-service.
But how can you prepare your practice for all that’s involved in a risk-bearing model? Parts of the transition to value-based care can be complex, but not everything needs to be overwhelming. Here are four things you can start thinking about and working on right now to determine your readiness and to help you prepare for when you do decide to take the leap.
To be successful in value-based care, providers need to pay extra attention to their highest-risk patients and make sure their needs are addressed in a proactive and cost-effective manner. In many cases, high-risk patients are dealing with not only various social determinants of health, but multiple co-morbidities—which means greater risk of complications, hospitalizations, and emergency department misuse. All of these drive up healthcare costs.
Population size matters too. Small patient panels can make it hard to perform well—especially in practices that have a fair number of high-risk patients.
Many small practices find that teaming up with other independent practices and joining an accountable care organization (ACO) helps offset risk. From a payer perspective, ACOs help to spread risk among a much larger patient population, making ACOs more attractive partners in a value-based model.
How familiar are you with your patient population? Now is the time to dive into your records. If you don’t have the tools to collect and analyze this important data, invest now. Data is critical to all decision-making in value-based care. Finally, consider joining an independent physician association or ACO if you feel you need additional support or resources to get your feet off the ground.
Yearly physical exams and annual wellness visits (AWVs) are both important tools for keeping patients healthy and preventing more complex issues, but they are vastly different. Everyone is eligible for physical exams, but AWVs are a zero-cost benefit for Medicare beneficiaries only.
When entering a value-based model, providers need to understand the differences, code them properly, and explain to their patients what to expect in an AWV to avoid confusion on their part.
Unlike physical exams, annual wellness visits don’t involve any physical contact with a provider other than taking vitals such as weight and blood pressure. AWVs are more of an in-depth discussion between the patient and provider to go over medical history, review medications and risk factors for disease, and create a personalized health maintenance plan.
Annual wellness visits are important for patients because they identify care gaps that could impact long-term health, improve quality of care, reduce healthcare costs, and increase the rate of screenings and vaccinations.
For providers, meeting AWV benchmarks yields greater shared savings and revenue.
Be prepared to implement annual wellness visits in your practice to a greater extent, if you don’t already. Create templates to ensure smooth appointments. Invest in data management tools to easily identify patients who are due for AWVs. Finally, learn how to code for AWVs so you get paid properly and patients don’t get charged erroneously.
Satisfied patients will keep coming back to the same provider, forging a trusted long-term relationship. But just one bad or frustrating experience can send a patient running to another practice.
Providers should take a close look at patient experience at their practice—friendliness and productivity of front office staff, ease of scheduling, error-free billing, seamless communication, timeliness of practitioners, and more.
Each of these elements plays a part in patient satisfaction and boosts engagement. Engaged patients are healthier and more proactive in their medical care.
There are plenty of ways to enhance patient experience, including:
Creating partnerships with different professionals, organizations, and services across medical disciplines can maximize a provider’s ability to manage transitional and outpatient care.
For example, nurses/care managers assess complex patients and provide care coordination and education to improve patient self-management, which prevents costly and avoidable emergency department use.
Likewise, community health workers help patients address social determinants of health and connect them with resources to close care gaps, improve health outcomes, and reduce care fragmentation.
These highly skilled resources are often available through ACO partnerships.
Start thinking about where partnerships may benefit your practice. You may also consider teaming up with a value-based/managed service organization like Innovista Health to get extra support in all facets of value-based care—from quality improvement and care management to data analytics, risk adjustment, and more. With comprehensive support from various partners, you can spend more time focusing on patient care, which makes everyone’s experience much more fulfilling.
The healthcare system is undergoing a monumental shift, and there is no better time than now to start exploring the process and possibilities under a value-based model. Part of preparing for the shift involves thinking about these and other factors so your future in value-based care can be successful and rewarding.