Legislation and programs outside the Affordable Care Act have passed in the last decade affecting the way healthcare organizations get paid, including the recent Merit-Based Incentive Payment System in 2019. These multifaceted efforts have been made to shape value-based care alternatives to the fee-for-service model, which incentivizes hospitals based on the quantity of services rendered. As has been well documented, the negative implications of fee-for-service surpass the call for unnecessary tests — creating waste of valuable medical resources, including labor, as well as heightened costs distributed across all parties — and have spread to the heart of the healthcare system, creating skepticism and confusion where trust and clarity belong.
How can organizations work to ensure that the changes undergone to implement value-based care have the greatest impact? The answer goes beyond the technology driving it or the operational changes made to accelerate adoption or even the big one — billing — whether improving the viability of providers through adjusted reimbursements and potential revenue gain or passed through to patients with fewer line item costs.
Are people noticing an uptick in quality of care? And just what does it take — at the individual, facility-focused, or system-wide level — for effort put into the changes to-date to reflect in the actual and perceived levels of care received? We have seen that the answer to vitality — for both business and public health — isn’t always more, more, more. With the switch to value-based care and metrics inherent within it, quality is king. Hospitals must consider a few key things to keep up with the changes to see the fruits of their labor sustained long enough for the benefits to really sink in.
- Setting realistic benchmarks The longer an organization has adopted value-based care incentives, the more difficult it will be to continue to exceed expectations year over year — a key part of the equation as to whether an organization is rewarded or penalized. Eventually, maintaining strong metrics that meet industry-leading benchmarks should warrant rewards or risk tapered interest in value-based care incentives long term. Providers who are reluctant to adopt value-based care incentives may be overwhelmed by the investment of resources and the increased regulatory oversight that comes with it; in fact, provider engagement is most cited by payers in Business Insider’s recent report as the top impediment to successful value-based care (32%). Providers will need to see a clear path to value — for patients and for their reimbursement processes — so that they can continue to offer the volume of care demanded of them.
- Making feedback effortless While readmission and immunization rates are hard data measured for value-based care reimbursement, the potential for noteworthy change is most stark for high-volume centers (who stand to benefit most in the short-term, at least, from quality improvements set against such benchmarks). Patient feedback, however, is something that can be illuminating no matter the size of the facility. It’s no secret that patient experience can be a slightly difficult metric to score, however; and while patient care is paramount for providers, hospitals aren’t always a place where joyful, loyalty-inspiring moments unfold. Making feedback easy to provide, using various physical and digital techniques, is one way that value-based care incentives can more accurately reward organizations where improvements are being made. New levels of interaction are needed to give life to improvements in engagement, otherwise feedback can be limited at best. Adopting best practices deployed in other industries is one way to make feedback a vital part of the mix, so that patient’s voices are more routinely heard and accounted for — through reimbursements and individualized care alike.
- Assessing digital health After provider and patient engagement, the next biggest obstacle to success noted by the report is the technology infrastructure supporting new value-based care initiatives and existing patient and operational data. A digital health assessment identifies new opportunities for feedback and benchmarking to be more accurate and insightful, aiding in the collection of data, the tools used for innovation and revenue generation, and other pieces of the puzzle that sustain hospitals and care centers even as the details of value-based care are ironed out.
About more than reimbursements Value-based care is worthwhile for many reasons, not least of which is improving the way that decisions are made within hospitals and how those decisions correspond to the money they receive from government programs and payers alike. Another central benefit is that many of these changes offer immediate benefit directly to the patient: shortened stays and more targeted tests, for example. What value-based care needs most is time — a resource always in too short supply — so that the commitment to quality is seen and felt by a critical mass, for continued buy-in and investment.
Ready to assess the digital health of your organization? Want to be sure you’re considering all facets of value-based care? Let’s talk.