Creating Consistent Success in Value-Based Care

There is a tried-and-true process for transitioning into value-based contracts. I’ve analyzed this step-by-step framework in detail, but here is a quick summary to start us off:

1. Solidify the Base of Your Practice Management
2. Upgrade Your Patient Experience
3. Implement the Fundamentals of Value-Based Care
4. Take Greater Responsibility for the Totality of Your Patients’ Care — and Costs
5. Move Into Advanced Risk Models

However, once you have transitioned, succeeding consistently in these arrangements is another challenge altogether. For example, one group may thrive and generate tremendous savings in the Medicare Shared Savings Program (MSSP) only to lose money in a commercial program. A group may get lucky with a banner year in shared savings, only to find it difficult to repeat that success in subsequent years.

Your goal should be to create a systematic process for delivering consistent performance in value-based care, whether across programs or across years. Your transition to value-based care depends on it; otherwise, value-based care will remain a “side hustle,” without the primary focus of the organization.

To create that consistency, here are some tools, solutions, and strategies to help you create consistent success in all varieties of value-based arrangements.

Optimize Your EHR to Find Valuable Data

While an electronic health record (EHR) is a common source of complexity and frustration, you can benefit in value-based care by utilizing the full potential of these powerful systems. A robust EHR is critical for population health management and care coordination, two cornerstones of value-based care.

According to Intelichart, “using different, isolated technology platforms that don’t talk to each other is one of the most significant challenges of value-based care.” In order to avoid fragmented or siloed care, tools and technology should integrate with your electronic health record (EHR). And ideally, your tools should sit within the “native” EHR experience (as in, sitting on the same screen), without requiring you to click out and login to another application outside your EHR.

An EHR that is optimized for value-based care must include the following capabilities:

• Quality. Your EHR should highlight quality gaps, customized by program, at the point-of-care, making it easy for your staff and providers to close clinical quality gaps right when the patient is in the visit (i.e., not calling them after the fact).
• Risk Adjustment. Your EHR should present both recapture and suspect conditions at the point-of-care and allow a review by a coder before claims are submitted. This enables providers to document and code a patient’s conditions accurately, limiting compliance risk.
• Referrals. Your EHR should create an informed referral for providers, by tiering specialists and facilities by high/low quality. And ideally, by presenting more details, such as in-network status, patient cost-share, and payer quality ranking, right within the order workflow.
• Clinical Programs. Your EHR should make it easy to identify patients at risk and refer them into relevant programs or additional services, such as chronic care management (CCM), behavioral health, or other clinical programs to support the patient.
• Utilization. Your EHR should include information on when the patient has accessed services outside of your group, such as when they’ve gone to the emergency room or been discharged from a hospital.

Leveraging an EHR’s tools at the point-of-care makes it easier for provider groups to deliver consistent value to their patients, every single day. When the data or actions are living outside the EHR (such as sitting somewhere in a payer portal), it’s far more difficult to create consistent value, year-over-year.

Implement Tools to Optimize Operations and Care Delivery

Consistent success in value-based care models requires a shift in attention and reprioritizing of daily duties. There are several tools that can help create space and increase bandwidth so that providers can dedicate more time and attention to value-based initiatives.

• Virtual Access and Telehealth. Creating access for patients, in every way possible, is a fundamental strategy in any value-based care arrangement. Creating more access through virtual avenues, such as telehealth, can make it easier for patients to see their doctor for immediate care. This avoids unnecessary visits to more expensive sites of care. Telehealth can also increase patient satisfaction, which is crucial for retention and often a key metric of value-based contracts. Furthermore, the convenience of telehealth can encourage additional touchpoints for care teams to manage chronic conditions and fulfill value-based metrics.
• Virtual Scribe. Using a virtual scribe service can ease documentation burden and give physicians more time and capacity. Physicians can use this time to see more patients, offsetting the costs of the virtual scribe service. In a value-based model, seeing more patients can grow attribution. Additionally, providers can repurpose this time to identify and meet performance metrics that increase quality-based reimbursements.
• Patient Portal. A robust patient portal that allows patients to message their care team and receive important reminders, keeping patients connected to their providers. An intelligent patient portal can also send notifications to get patient-reported information that can close care gaps, thereby increasing value-based reimbursements.

These EHR tools can benefit patients and providers in both fee-for-service and value-based arrangements while helping to bridge the two. This dual purpose can streamline the transition to value-based care and improve performance once enrolled in alternative payment models.

Offload, Delegate, and Partner to Prioritize Clinical Care

In order to unlock the full potential of these tools, care teams should regularly invest time and effort into reviewing their workflows. Teams can incorporate this into daily huddles or weekly practice meetings. Whatever method is used, the goal is to create an ongoing ritual or cadence for the team to review performance, progress, and adapt continuously. This strategy allows for gradual tweaks and avoids massive, one-time adjustments that can backfire and make value-based care intimidating.

When reviewing workflows, practices should look for — paradoxically — tasks that can be eliminated from the workflow or reassigned. According to one survey, physicians could delegate about 30 percent of their workload to non-clinical staff and automate 18 percent. Offloading certain duties can free physicians to focus on patient care, which is important in both fee-for-service and risk- or value-based frameworks.

Ongoing rituals can also help to review and adjust roles to suit value-based care. A team-based, patient-centered approach helps foster consistent success in value-based arrangements. As a report by McKesson noted: “Everyone at the practice, from the front office staff to the physicians, to the supportive care team, must work together to provide patients with the best care possible while ensuring all requirements are met.” Strong billing and knowledgeable front office staff are crucial. According to McKesson researchers, “Practices that are the most successful have strong front office and billing leadership … will greatly reduce the amount of manual intervention needed to meet tracking and reporting requirements.”

Smaller practices especially stand to benefit from this increased bandwidth because lack of resources is a frequent obstacle to implementing value-based care. Aligning with a management services organization (MSO) can further reduce administrative burden, enabling physicians to focus on understanding and implementing value-based processes.

In addition to partnering with an MSO, providers should consider entering local, physician-led governance. These bodies can create opportunities for providers to share knowledge and best practices, collaborate to educate each other, build a cost-efficient referral network, and more. As researchers from Health Catalyst observed, the best governance is one that “educates, engages, and energizes clinicians and stakeholders” to support “difficult financial, clinical, and patient-focused decisions over the long-term.”

Together, these various tools and strategies can help practices succeed in and grow their value-based care arrangements.

Subscribe to inforMD to stay updated on healthcare’s latest news and find tips and tricks to optimize your practice!