According to the American Medical Association (AMA), value-based care is defined as “the best care for the patient.”1 Under value-based care, healthcare stakeholders are concerned about patient safety, health outcomes, and how satisfied patients are with their care experience Value-based care is intended to be a recipe for improved patient healthcare at reduced costs.1
The COVID-19 pandemic has placed a renewed focus on the importance of providing patients with high-value care. But what, exactly, is considered “high-value care”? And how can healthcare stakeholders deliver treatment that is considered “high-value”?
The AMA defines five key components of a healthcare system that delivers high-value care:1
- Healthcare professionals with a clear, shared vision.
- Healthcare workers demonstrating leadership and professionalism.
- A robust healthcare IT infrastructure.
- Broad access to care.
- Reimbursement models that remove incentives for volume-based care
In this article, we explore how the COVID-19 pandemic has contributed to a shift in focus to these key components of a high-value healthcare system. We also share how Veradigm can work with your healthcare team, to help support and drive value-based care.
1. Healthcare Professionals with a Clear, Shared Vision
The AMA defines an important component of a high-value healthcare system as a shared vision for that system.1 There is no doubt that the coronavirus pandemic has been a crisis for the healthcare community and communities all over the United States and the world. While challenging, times of crisis can call into focus the need for a clear, shared vision. By unifying all of us behind the inescapable reality of the virus and its effect on our society, the coronavirus pandemic has done just that.
The coronavirus has also provided a clear, shared vision of the existing barriers to healthcare in our society. COVID-19 has clearly had greater effect on those of lower socioeconomic status. More children test positive for COVID-19 in households with lower incomes than in wealthier households.2
COVID-19 exposure, infection, and death are also strongly influenced by race and ethnicity. The Centers for Disease Control and Prevention (CDC) reports that social inequalities have put people from racial and ethnic minority groups at increased risk of getting sick or dying from COVID-19.3 In Milwaukee County, Wisconsin, Black Americans make up 26% of the population. They account for 73% of the COVID-19 deaths. Similarly, in Dougherty County, Georgia, Black residents make up 69% of the population. However, they account for 81% of the COVID-19 deaths.4
COVID-19 has unified our nation behind the need to provide more equitable access to healthcare.3
2. Healthcare Workers Demonstrating Leadership and Professionalism
COVID-19 has provided a unique opportunity for healthcare workers to demonstrate leadership and professionalism. Healthcare workers have filled the roles of “essential workers” in doctors’ offices, hospitals, emergency rooms, and other medical facilities. They have continued to work even when they are at higher risk of exposure to the virus. Despite the risks, healthcare workers have found themselves working longer than usual hours, while on their feet, and often without breaks.5
From these positions of leadership and on the front lines, healthcare workers can help guide medical professionals toward high-value care. They can identify gaps in care that might lead to errors, such as treatments that will lead to avoidable complications. They can also identify and eliminate interventions that may harm the patient or provide little benefit. From the front lines, healthcare workers are able to single out system-level opportunities to reduce costs.1, 6 In the process, healthcare workers can help strengthen the focus on value-based healthcare.7
3. Robust IT Infrastructure
Another key component of value-based healthcare is a robust IT infrastructure. COVID-19 has made face-to-face meetings with healthcare workers more and more challenging.8 Telemedicine has emerged as an essential piece of the healthcare puzzle during the COVID-19 crisis. A robust IT infrastructure is essential to support telemedicine.8, 9
Telemedicine enables both patients and healthcare workers to abide by social distancing guidelines.10 By doing so, it helps protect healthcare workers and patients from exposure to the virus. It may also free up medical resources so they will be available for patients with the greatest need.11
Maintaining accurate patient records is key to practicing telemedicine successfully.10 Electronic health records (EHRs) give medical professionals access to patients’ medical records and treatment history regardless of their location.
Having a robust health IT infrastructure is also key to advancing our understanding of coronavirus and its implications for our society. Through the use of EHRs and other electronic data capturing technologies, researchers are able to leverage real world data (RWD) to derive actionable insights regarding COVID-19. Health IT has enabled the development of the COVID-19 Research Database (of which Veradigm is a founding member) and the COVID-19 Healthcare Coalition. As COVID-19 vaccines become more widely available, health IT will also help support vaccine tracking activities and real-world safety surveillance.
4. Broad Access to Care
Another key component of high-value care is broad access to care.12 Data show that COVID-19 has disproportionately affected those from lower socioeconomic strata when compared to those from wealthier households. It has highlighted the need for broad, equitable access to healthcare regardless of income or social status.2, 4
Telemedicine is one of the tools healthcare professionals have put into place to continue working during the pandemic. One positive result of telemedicine is that it has made healthcare more broadly available. It has brought the possibility of healthcare to patients who were previously cut off from it by location or a lack of reliable transportation.13 In mid-March 2020, in response to the COVID-19 crisis, the Centers for Medicare and Medicaid Services (CMS) expanded the types of patients they classified as eligible for telemedicine services. They also expanded the modalities through which telemedicine could be delivered. Both of these brought high-value care to a broader cohort of patients.8
5. Removing Incentives for Volume-Based Care
Economists have long argued that the existing model of volume-based healthcare reimbursement is inefficient. They have criticized that volume-based healthcare, also known as fee-for-service healthcare, incentivizes healthcare providers to do more tests, procedures, visits, and so on to increase revenue. Fee-for-service reimbursement provides payment for each individual service the healthcare provider performs.14 As a result, it rewards the most expensive treatments, tests, and forms of disease management a healthcare worker provides.15
The COVID-19 crisis has shifted healthcare away from the fee-for-service model.7, 15 Social distancing guidelines limit the number of patients permitted in hospitals and doctors’ offices. This decreases the number of services administered to patients. In many regions, social distancing also caused the temporary suspension of elective procedures. A recent survey showed that nearly 70% of patients are concerned about getting COVID-19 if they visit the doctor for non-COVID-related causes. This makes it clear why so few patients are venturing into medical facilities.14, 15
By decreasing the volume of patients served at most medical facilities, COVID-19 has minimized incentives for volume-based care. As a result, increasingly medical organizations are searching for ways to improve their ability to deliver quality care at lower prices.16 Providers are shifting to a new paradigm of patient-centered service. As part of the shift to value-based care, many healthcare stakeholders are:
- Searching for ways to improve the quality of care they deliver,
- Analyzing workflows to find routes to improve patient outcomes,
- Redesigning incentives and payment structures to support the principles of proactive, preventative healthcare, and 17
- Working to identify gaps leading to waste and overuse.6
A Partner to Help Drive Value-Based Care
No matter how you fit into the healthcare system, Veradigm can work with you to drive value-based care, especially as we navigate to a future beyond COVID-19.
- For healthcare providers, we offer a wide range of solutions that can support improved outcomes and reduce patients’ out-of-pocket costs.
- Veradigm’s suite of BioPharma and Device solutions can help you discover timely, actionable, real-world evidence to improve patient experience and outcomes.
- For health plans and payers, solutions from Veradigm can help deliver insights to drive quality outcomes in a cost-efficient way
If you would like to learn more about how Veradigm can support you through the transition to value-based care, feel free to contact us and we’d be happy to work with you.
- American Medical Association. Value-Based Care: Health Systems Science Learning Series. 2019. https://edhub.ama-assn.org/health-systems-science/interactive/18028223.
- Gathright J. Study Finds Significant Racial, Socioeconomic Disparities In COVID-19 Among Children. Updated August 7, 2020. Accessed February 12, 2021, https://www.npr.org/local/305/2020/08/07/900166845/study-finds-significant-racial-socioeconomic-disparities-in-c-o-v-i-d-19-among-children.
- Centers for Disease Control and Prevention. Health Equity Considerations and Racial and Ethnic Minority Groups. Updated July 24, 2020. Accessed February 12, 2021, https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html#print.
- Price-Haywood EG, M.D., M.P.H., Burton J, Ph.D., Fort D, Ph.D., Seoane L, M.D. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med. June 25, 2020 382(26):2534-2543.
- Goldhill O. ‘People are going to die’: Hospitals in half the states are facing a massive staffing shortage as Covid-19 surges. Updated November 19, 2020. Accessed February 12, 2020, https://www.statnews.com/2020/11/19/covid19-hospitals-in-half-the-states-facing-massive-staffing-shortage/.
- Smith TM. What is value-based care? These are the key elements. AMA website. Updated January 10, 2020. Accessed February 10, 2021, https://www.ama-assn.org/practice-management/payment-delivery-models/what-value-based-care-these-are-key-elements.
- Sokol E, MPH. Coronavirus Pandemic Impacts Value-Based Contracts. Revcycle Intelligence website. Updated September 8, 2020. Accessed February 9, 2021, https://revcycleintelligence.com/news/coronavirus-pandemic-impacts-value-based-contracts.
- Arellano K, Bains J, Bastian N, et al. The Financial Impact On Providers and Payers in Colorado. THE VALUE OF TELEMEDICINE DURING THE COVID-19 PANDEMIC RESPONSE. September, 2020. Accessed February 13, 2021. https://oehi.colorado.gov/sites/oehi/files/documents/The%20Financial%20Impact%20On%20Providers%20and%20Payers%20in%20Colorado.pdf
- Colorado Health Institute. Value and Impact of Telemedicine During the COVID-19 Response. Updated November 13, 2020. Accessed February 13, 2021, https://www.coloradohealthinstitute.org/research/value-and-impact-telemedicine-during-covid-19-response.
- Impact of COVID-19 on Telehealth. American Health & Drug Benefits. June 2020 13(3):125-126.
- Hoffman DA. Increasing access to care: telehealth during COVID-19. Journal of Law and the Biosciences. 16 June 2020 7(1):1-15.
- What Are the Components of Value-Based Care? (Interactive Course). https://edhub.ama-assn.org/health-systems-science/interactive/18028223.
- Arellano K, Bains J, Bastian N, et al. Insights From Patients in Colorado. THE VALUE OF TELEMEDICINE DURING THE COVID-19 PANDEMIC RESPONSE. September, 2020. https://oehi.colorado.gov/sites/oehi/files/documents/Insights%20From%20Patients%20in%20Colorado_0.pdf
- Brown B, Crapo J. The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement. 2017:1-7. 2017. https://downloads.healthcatalyst.com/wp-content/uploads/2014/07/The-Key-to-Transitioning-from-Fee-for-Service-to-Value-Based-Reimbursement.pdf
- Meuse D. Is COVID-19 the End of Fee-for-Service Payment? Princeton University. Updated May 29, 2020. Accessed February 15, 2021, https://www.shvs.org/is-covid-19-the-end-of-fee-for-service-payment/.
- Leventhal R. How Has COVID-19 Impacted the Value-Based Care Movement? healthcare innovation website. Updated September 15, 2020. Accessed February 9, 2021, 2021. https://www.hcinnovationgroup.com/policy-value-based-care/alternative-payment-models/article/21154317/how-has-covid19-impacted-the-valuebased-care-movement.
- Aledade. Assessing Your Goals and Objectives for Value-Based Care. 2019. Accessed February 10, 2019. https://resources.aledade.com/white-papers/assessing-your-goals-and-objectives-for-value-based-care.