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Shifting to Value-Based Care: Four Strategies Emphasize Agility
Article Summary
As the healthcare payment shift from fee-for-service (FFS) to value-based reimbursement takes longer than expected, health systems must balance existing volume-based models with a growing emphasis on value. Organizations are in different phases of the journey from volume to value, and policies continue to evolve. In response, the industry’s best stance is to sustain FFS revenue while following guidelines and strategies to be increasingly ready for value.
Organizations can use four methods to remain agile as they navigate the limbo between volume and value:
1. Understand the first ten years of value-based care and prepare for what’s next.
2. Identify essential strategies for shifting from volume to value.
3. Leverage the Medicare Shared Savings Program.
4. Use population health management as a path to value.
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Taylor Larsen
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基于价值的医疗服务(VBC)的一个常见主题是，从数量或服务费用(FFS)到价值的转变所花费的时间比医疗保健行业预期的要长。这一延迟使过渡过程变得复杂，因为各机构知道他们必须为VBC做好准备，但仍然依赖FFS报销的收入。此外，COVID-19可能会以某种方式影响到VBC的转型，但专家们对疫情是否会加速或放缓转型仍存在分歧。
由于存在如此多的未知因素，组织必须继续支持基于量的报销，并保持敏捷，准备在时机成熟时向更有价值的方向前进。卫生系统可以通过整合策略和指导方针，在维持数量的同时为价值做准备，来应对偿付的困境。
Shifting to Value-Based Care: Four Ways to Balance Volume with Value
The following four approaches can help health systems balance volume with value
Understand the First Ten Years of Value-Based Care and Prepare for What’s Next
The year 2020 marked a decade since the passage of theAffordable Care Act2010年，医疗保健从量到值的第一个过渡步骤。随着该行业在2021年进入另一个有价值的十年，卫生系统必须考虑到目前为止这些规划的影响，并确保他们拥有在一个日益受价值驱动的行业中取得成功的流程和工具。The10-year VBC progress reportis mixed, as CMS and healthcare organizations are still evolving and adapting policies and strategies to optimize outcomes and performance. For example, while CMS’s emphasis on quality and cost is driving an upward trend for patients and providers with substantial improvement in readmissions, organizations still need to simplify and consolidate value-based programs for more widespread positive impact.
Identify Essential Strategies for Shifting from Volume to Value
The healthcare industry issuspended between value- and volume-basedpayment models, as unaffordability pushes the shift to value, but the current environment still supports volume. Health systems must understand the factors driving and sustaining both payment models and strategies for balance as value replaces volume to survive economically. Ten strategies can help health systems balance VBC with FFS:
- Maintain member perspective.
- Make cautious investments in hard delivery assets.
- Accelerate investment in digital infrastructure.
- Introduce innovative digital engagement solutions.
- Make pricing concessions.
- Align incentives.
- Manage networks.
- Build payer-provider trust and collaboration.
- Align clinicians and administrative team members.
- Encourage physician leadership and accountability.
Leverage the Medicare Shared Savings Program
从历史上看，为老年医保患者提供医疗服务给医疗系统带来的利润非常微薄。However, value-based programs, such as theMedicare Shared Savings Program (MSSP), are now making Medicare patients a potentially lucrative population for organizations while also helping providers deliver the highest level of care to patients and communities. Under MSSP, health systems can optimize their Medicare-based revenue when they do the following: aggregate and analyze data, align financial incentives between payers and providers, engage patients in behavior or lifestyle modifications, and garner support from clinicians and encourage them to lead the shift to VBC.
Use Population Health Management as a Path to Value
As VBC definitions and goals continue to shift, organizations can move forward usingpopulation health management (PHM)strategies as a path to value. Population health is a data-driven strategy focused on the proactive management of a given population’s health by a defined network of financially linked providers, achieved in partnership with the community. The PHM path to value includes working withMedicare Advantage(a good growth opportunity with low barriers to entry); focusing on ambulatory, not acute, care as it delivers more value; leveraging registries based on utilization to identify the most impactable 3 to 10 percent of utilizers; and simplifying the physician burden by focusing on reasonable measures.
The Long Road to Value
As health systems find themselves in different phases of the journey from volume to value, and policies continue to evolve, the industry’s best stance on VBC is likely an agile one. Organizations will need to sustain FFS revenue while following guidelines and strategies to be increasingly ready for VBC.
Additional Reading
你想了解更多关于这个话题吗?Here are some articles we suggest:
- 2021 Changes to the Quality Payment Program: Must-Know Guidelines for ACOs
- Value-Based Care: Four Key Competencies for Success
- Analytics Enables Value-Based Care Transformation
- Activity-Based Costing in Healthcare During COVID-19: Meeting Four Critical Needs
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