September 10, 2019 Mark A. Caron, CHCIO,
FACHE, CEO
The
healthcare industry is in the midst of a challenging transition to value-based
care. Many expected the change to happen more quickly. Yet payers, especially
large ones like Cigna and Aetna, remain committed to value-based care, and
hospitals and physician organizations are inching towards taking on more risk.
Nevertheless, the payment model is expected to account for 59 percent of healthcare payments by
2020.
At
Geneia, we work closely with health plans, hospitals and physicians evolving to
value-based care. In the course of our work, we have discovered that the most
successful organizations are using some or all of these best practices.
Best Practices for
Transitioning to Value-Based Care
·
Employee Experimentation: Your
employees can be an incubator and learning lab for innovation. Healthcare
organizations often are large employers. Hospitals, for example, are
the largest employers in 16 states. Most large employers self-insure
employee health benefits, meaning they have the flexibility to experiment to
improve engagement, chronic illness management and especially wellness efforts.
Research suggests employer wellness
programs have had little impact at the population level yet we
know the way to combat the prediabetes epidemic is by engaging employees in
exercise and better food choices, making this area one that is ripe for
innovation and experimentation. Successful innovations can then be deployed to
patient populations.
·
Employer Partnerships:
Hospitals and physician organizations are partnering with employers in the
community. With health costs projected to increase another five percent
in 2020, large employers are keenly interested in more closely aligning
themselves with healthcare systems to improve access to primary care, virtual
care and more.
The
practice of direct contracting between hospitals and employers has gained
steam. According the National Business Group on Health, nearly half of its
members either are already directly contracting with providers or
planned to do so in 2019. Nearly a third of employers plan to implement an
accountable care organization (ACO) and/or high-performance networks, and that
percentage could nearly double to 60 percent by 2022.
·
Patient Relationship Management (PRM):
Surround the patient in engagement and use technology to share patient
information with all healthcare stakeholders. As Geneia’s head of product
management wrote in a blog, healthcare needs to leverage the best of
retail and CRM (customer relationship management) techniques to better
understand patients and personalize engagement:
“I imagine a future in which a CRM approach is taken with every
patient, whereby the essential historical views are available to the right
caregiver, and a patient’s level of risk (healthy, rising, chronic or
catastrophic) and social needs (socioeconomic,
transportation, healthy food, mental health) are used to direct the patient to
the ideal location for services whether that’s a physician office, a retail
pharmacy, urgent care center or even the home in the case telemedicine
and remote patient monitoring.”
·
Physician Misery: Physician burnout is potentially as
deadly as the diabetes epidemic and every healthcare organization has a role to
play in improving physician satisfaction. Physicians and other clinicians are
the heart of value-based care yet Geneia’s national survey found:
·
80 percent of physicians say they are personally at risk for
burnout at some point in their career
·
Nearly all surveyed doctors (96 percent) report they have
personally witnessed or personally experienced negative impacts as a result of
physician burnout.
Savvy
healthcare organizations are committing to reducing commonly-accepted physician frustrations such
as improving EHR workflows, identifying and mitigating patient social
determinants of health (SDoH), wearing the Joy of Medicine pin, and more.
·
Clinical Integration: Payer
provider clinical integration enables access and exchange of care management
data such as SDoH within the EHR as well as clinical quality and admissions,
discharges and transfers (ADT) for transitional care management. As I’ve
written before, today’s world of isolated EHRs and health information exchanges
(HIEs) was not designed to handle collaborative patient care across care teams,
especially where care teams span multiple health systems. Healthcare
organizations hoping to achieve value-based care success need to look beyond
the EHR to solutions offering a tier of patient data enrichment, modeling,
scalability and decision support that can be integrated into the clinical
workflow and shared across every cost and care setting.
Undoubtedly,
the healthcare industry is making progress in achieving the goals of
value-based care. A Change Healthcare study earlier
this year found, “48 states have now implemented value-base care or payment
programs, 50 percent of those programs are multi-payer in scope, and just four
states have little or no value-based care initiatives underway.” Nonetheless,
more needs to be done to fully engage patients, physicians, hospitals and
employers in value-based care in the way payers are.
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