Value-Based Healthcare: A Healthcare Provider's Guide

Blog Posts  |  22 September 2020  |  By Amanda Cohen, MPH

Value-based healthcare is becoming an increasingly common reimbursement model for physicians. Implementing a value-based care model has the potential to improve care for patients and reduce healthcare inefficiencies. In this article, we examine what value-based care is and how you can begin to implement it in your own practice.

What is value-based healthcare?

In contrast to the traditional “fee-for-service” model that determines payment based on the services used, “value-based healthcare” is a healthcare approach in which providers are compensated based on patient health outcomes. The value-based healthcare model focuses on increasing the quality of care, rather than relying on the number of patients treated.

Value-based care places an emphasis on improving patient outcomes and measures how well healthcare providers promote quality care for their patients. More specifically, value-based healthcare models utilize specific measures such as reducing hospital readmissions, using certified health IT, and improving preventive care as benchmarks for quality.

Now that we have defined value-based care, let’s explore how you can implement this model.

Assess your organization’s structure

To start providing value-based care, first compare your current operations against best practices of value-based healthcare. If you are part of a practice or hospital, consider becoming an Accountable Care Organization. As an ACO, you would join a coalition of value-based care providers. Centers for Medicare and Medicaid Services rewards ACOs for providing quality care to patients on Medicare.1,2

In assessing structure, it is important to note the amount and types of patients your organization serves. When you examine your organization’s structure in detail there are a series of questions you may want to ask yourself. For example:

  • Do many of your patients rely on Medicare?
  • Is your organization affiliated with a hospital health system with a diverse group of patients?
  • Is your organization utilizing health information technology (HIT)?

As you initiate a value-based healthcare model in your organization, you will need to identify and evaluate current waste and gaps in care.

Embrace technology

After assessing your organization’s structure, consider the value a robust IT infrastructure can add. Your IT infrastructure will likely include an electronic health record and population health management tools.3

If you are a small practice, however, the notion of a “robust infrastructure” may be daunting. Fortunately, Veradigm offers an electronic health record system designed specifically for small independent practices — Practice Fusion. For midsize physician practices and ACOs, consider Allscripts Professional Electronic Health Record for streamlined operations and improved revenue.

Roughly 49% of all hospitals report utilizing a population health management tool.3 These tools can help track quality of care and trends in chronic disease within large and small populations. For practices switching to a value-based care model, we recommend The dbMotion Solution to organize patient records and drive efficiencies.

Once individual patient data has been organized, you can utilize Allscripts Population Health Analytics to monitor, manage, and measure performance, and maximize reimbursement in value-based care initiatives and programs.

Quantify impact

To quantify the impact of your value-based care model, many measurement tools follow a Donabedian approach. In this method, measures of success fall into three categories: structures, processes, and outcomes.

  • Structural measures refer to supporting structures that may expand access or ease of care to patients.
  • Process measures refer to processes of care.
  • Outcome measures include health status, patient-reported outcomes, patient experience, and quality of life.4

Quantifying the impact may also illuminate areas where a value-based care model is making a difference for your patients. For example, using your IT infrastructure to send pre- and post-visit questionnaires can aid in elevating your healthcare and improve quality of care for patients.

What success looks like in value-based healthcare

As a provider, you may have an idea of what success looks like when it comes to value-based healthcare. But what does value-based healthcare mean for patients — specifically, within certain patient populations?

The Institute of Medicine has developed the “STEEEP” methodology that describes high-value care as5:

  • Safe
  • Timely
  • Effective
  • Efficient
  • Equitable
  • Patient-centered
Following STEEEP and the guidance above has the following benefits:
  • It creates a value-based, patient-centric healthcare model in your practice
  • The payment model changes to reward quality of recovery over quantity of patients
  • IT infrastructure is designed to support growth

Using a value-based care model, we can reimagine the interactions between the provider and patient to create a culture of quality and wellness.

As the healthcare industry evolves, Veradigm is here to help you, and your practice, adapt. We will be revisiting this topic soon, so stay tuned to learn more about the best practices for value-based healthcare.


References:

  1. CMS Value-Based Programs. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs. Accessed September 2, 2020.
  2. CMS Shared Savings Program. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Medicare-fee-for-service-payment/sharedsavingsprogram/about. Accessed September 3, 2020.
  3. HealthITAnalytics. How hospitals invest in health IT for value-based care. https://healthitanalytics.com/news/how-hospitals-invest-in-health-it-for-value-based-care. Published September 30, 2019. Accessed September 2, 2020.
  4. Leung TI, Merode GGV. Chapter 14: Value-based health care supported by data science. In: Kubben P, Dumontier M, Dekker A (eds). Fundamentals of Clinical Data Science. Springer Open (Springer Nature Switzerland); 2018:193-212. doi:10.1007/978-3-319-99713-1_14.
  5. Gunderson G, Cutts T, Cochrane J. The Health of Complex Human Populations. National Academy of Medicine. https://nam.edu/perspectives-2015-the-health-of-complex-human-populations/. Published July 17, 2020. Accessed September 2, 2020.
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