The Affordable Care Act (ACA) of 2010 shifted the way healthcare in the United States (U.S.) is reimbursed.1 Previously, clinicians and healthcare providers were reimbursed based on the volume of services provided. Today, the U.S. healthcare market incentivizes healthcare providers to focus on the quality of services provided, rather than just the quantity of those services.2-3
This new healthcare model, called value-based care, has steadily gained traction in the U.S. over the past decade. In 2011, only three states had implemented value-based care programs. While in 2018, a whopping 48 states had begun participating in such programs.4
In this article, we share some of the benefits of value-based care and provide tips on how to stay ahead of the value-based care curve.
Benefits of value-based care
Value-based care compensates healthcare providers based on patient health outcomes. Providers are rewarded for reducing the burden of chronic disease and helping patients to live healthier lives.
Value-based care provides other benefits as well. Physicians focusing on value-based care are designing decision aids to walk their patients through different treatment options.2 These decision aids translate complex medical jargon and risk statistics into simple language and illustrations. They help doctors to guide patients into making informed treatment choices.2
Research shows that shared decision-making leads to better patient outcomes.2,5 For example, under value-based care models patients undergo fewer invasive procedures and are less likely to regret their treatment choices.2 With value-based care, patients are more likely to stick to their treatment plans.2
Research at the Robert Wood Johnson Foundation (RWJF) shows that patients who are actively engaged in their own health care are more likely to manage their health conditions and stay healthy.3 On the flip side, patients who don’t have the skills to manage their own health care often require more external health care. They often rack up higher healthcare costs.3,5
The benefits of value-based care are undeniable, and it continues to gain traction in the U.S. Follow these three tips to stay ahead of the curve:
1. Increase collaboration between health plans and clinicians
Value-based programs can help healthcare organizations and providers shift from volume-based, provider-centric systems to patient-centric, health-focused systems. Payer-provider collaboration focuses on meeting providers where they are and making tools available that support a provider’s path to high performance in a value-based program.
The rate of value-based program adoption is steadily increasing. This makes it essential to support the collaboration between payers and providers. While technology is only a piece of the payer-provider collaborative puzzle, Veradigm’s portfolio of solutions is well-positioned to help.
These technological innovations can help make the components of value-based programs transparent, while supporting high-performing, thriving provider practices. Getting at the heart of value-based care, these tools can ultimately help drive higher quality care, improve outcomes, and engage providers and patients in the care provided and delivered.
Pulse8, a business unit of Veradigm, provides value-based solutions and tools for payers and providers. Pulse8’s suite of solutions helps align payer and provider value-based contracts with quality improvement initiatives, cost containment interventions, improved outcomes and improved revenue.
The user-friendly Provider Portal within Collabor8 and the EMR integration of Integr8 allow providers to maximize gap closure rates while minimizing provider disruption. Pulse8’s products spare providers and their staff the annoyance and productivity drain of repetitious and sometimes unnecessary information requests by prioritizing and coordinating efforts to close gaps in documentation, coding and quality all at once.
For large health plans and aggregators, Veradigm eChart Courier™ is a medical chart retrieval solution that automates the chart retrieval process. eChartCourier eliminates the costly and time-consuming need for manual pulls. eChart Courier has direct access to Veradigm’s extensive provider network which includes the Allscripts EHRs.
2. Encourage your patients to become their own health advocates
To obtain the best medical care, it is critical for your patients to become their own health advocate. That means partnering in your patient’s health. Help your patients to feel comfortable by asking questions until they understand their health condition—even when the topic is embarrassing.2,4,5
Encourage patients to keep track of some key numbers: blood pressure, cholesterol, glucose level and testosterone or estrogen.5 Being their own health advocate can also mean encouraging your patients to bring a friend or relative along to their medical appointment (either in-person or virtually) for support.4,5
In 2012, a panel of medical experts concluded that patients were receiving too many medical tests. When you order a test, make sure the patient understands why they need it. What do you expect to learn from the test results? How will the results affect the patient’s treatment?5
To take a role in their healthcare decisions, patients also need to participate in decisions about prescription medications. Veradigm RxTruePrice™ can help patients do just that. RxTruePrice moves the prescription drug decision-making process back to the prescriber and patient by providing them with accurate, patient-specific cost and coverage information while they are still together in the actual or virtual exam room. Patients can inform physicians immediately if a selected prescription is too expensive. Physicians can then offer alternatives before the patient even leaves their meeting.
3. Embrace technology specifically made for independent practices
The independent practitioner is an essential part of the healthcare ecosystem. He or she needs the time to build strong connections with patients. The independent practice model gives physicians the autonomy they need to make treatment decisions based on evidence, best practices, and the patient’s health history.
Independent practitioners are critical in helping to avoid driving up the costs of healthcare.6 A “fee-for-service” business model can potentially lead to caregivers rushing through their patients and referring patients on to specialists, when it may be possible for them to be treated in primary care. In effect, there might not be time for physicians to treat all the cases that fit under their umbrellas when they’re trying to use a fee-for-service model.6
Practice Fusion is an electronic health record (EHR) system from Veradigm, designed specifically for independent practices. Practice Fusion is a cloud based EHR with a library of medical charting templates built for practices like yours. It streamlines charting and can adapt chart layouts to meet your specific needs. The patient summary provides patient information at a glance, while customization features enable clients to create shortcuts unique to each practice. Practice Fusion also offers advanced e-prescribing capabilities, including electronic prescribing of controlled substances, prior authorization management and allergy alerts. Automatic drug-drug and drug-allergy interaction checks help to improve prescription accuracy.
Veradigm can provide the tools and services needed to excel at value-based care and make sure you are staying ahead of the curve.
Talk to a Veradigm representative to learn more about Veradigm’s value-based solutions. The more you can engage your patients, the better they will be able to manage their own healthcare and healthcare decisions.
- Abrams M, Nuzum R, Zezza MA, Ryan J, Kisla J, Guterman S. The Affordable Care Act’s Payment and Delivery System Reforms: A Progress Report at Five Years. https://www.commonwealthfund.org/publications/issue-briefs/2015/may/affordable-care-acts-payment-and-delivery-system-reforms. Accessed December 9, 2020.
- Landro L. How to Get Patients to Take More Control of Their Medical Decisions. The Wall Street Journal. 2017.
- Blair M. Empowering Patients to Better Manage Their Health Results in Improved Health and Health Care. 2014; https://www.rwjf.org/en/library/articles-and-news/2014/03/empowering-patients-to-better-manage-their-health-results-in-imp.html Accessed December 10, 2020.
- Waldron T. The Future of Value-Based Care: 2019 Survey Results. 2019; https://blog.definitivehc.com/value-based-care-2019-survey-results. Accessed December 12, 2020.
- What We’re Learning: Engaging Patients Improves Health and Health Care. Quality Field Notes. 2014;3(March 2014):1-4.
- Dobro J. Why is the decline of independent primary care increasing your healthcare costs? 2017; https://www.onemedical.com/blog/healthy-workplace/increasing-healthcare-costs/. Accessed 13 December 2020.