How the Quadruple Aim and Value-Based Care Intersect

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Two frameworks get a lot of attention and play in the healthcare industry: the Quadruple Aim and value-based care.

These concepts offer new perspectives to reshape the way the healthcare industry operates at all levels, from structural changes all the way down to improvements to one-on-one doctor-patient appointments.

When we pinpoint where these models intersect, we see a clearer picture of the future of healthcare and the many ways value-based care can advance the Quadruple Aim.

Quick Definitions

Given how talked-about these concepts are, I think it’s important to define some key terminology.

For “value-based care,” I use the New England Journal of Medicine’s definition: “Value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.”

The “Quadruple Aim” builds off, you guessed it, the “Triple Aim.” The initial model focused on “enhancing patient experience, improving population health, and reducing costs.” The update adds another dimension: enhancing caregiver experience. This is especially important since the rate of physician burnout stands at 46 percent, according to the American Medical Association (AMA). Primary care, which is crucial to value-based care, is especially hard hit with 79 percent of providers experiencing burnout symptoms.

Enhancing the Patient Experience

As healthcare consumerization grows, patients have rightfully come to expect a higher-quality experience. After all, they’re paying far more out of pocket and demand to get their money’s worth. Today’s patients want a seamless, user-friendly, convenient experience that meets them where they are. That’s what they have come to expect from other products they buy.

Value-based care organizations must excel at the patient experience for two main reasons. First, they must attract and retain patients in an increasingly competitive world to ensure that payers “attribute” patients to their organization. Without any patients, what’s the point of your high-quality care? Second, most value-based programs now measure patient experience through surveys such as the Consumer Assessment of Healthcare Providers and Systems (CAPHS). In other words, you are directly rewarded for your higher (or lower) patient experience.

There are many tools that enhance the patient experience while accomplishing the goals of value-based care and the Quadruple Aim. At Privia, we focus on expanding the access of patients to care and increasing the connectivity of patients to their providers.

Telehealth is one of these “two birds with one stone” tools. The additional access can lower a patient’s chance of going to the emergency department for a condition that can be diagnosed and treated by a primary care provider … without even going to the office!

Telehealth may be as revolutionary to healthcare as online shopping has been to retail. Seeing your doctor from home on your phone or computer may seem strange today, but we said the same thing years ago about buying books, groceries, and mattresses online.

Similarly, patient portals enable patients to securely and easily message their provider, pay bills, view test or lab results, and more. These portals can also be used to gather patient-reported quality data to close care gaps, such as vaccinations or screenings. At Privia, our IT team closed nearly 12,000 care gaps automatically, saving our providers approximately 125 days’ worth of work and avoiding unnecessary doctor appointments.

Lowering Costs

Value-based care lowers the cost of care by avoiding costly and unnecessary patient encounters, such as, like I mentioned before, visiting an emergency room for a condition that could be treated by a primary care visit. By focusing on preventive care and reimbursing providers for delivering high-quality, evidence-based medicine, patients can enjoy healthier lives that cost the healthcare system less money.

Strong value-based organizations also focus on their vulnerable patients or the patients who utilize healthcare services the most. They do this through proactive outreach and management of a patient’s condition or multiple conditions, through ongoing follow-up with their provider and additional coordination by a care team. This counterintuitive “spend more to spend less” approach is fundamental to improving the health and cost of our sickest patients.

Another way value-based care saves the system money is through providers managing their network by making sure their patients get to the best care through specialists and other facilities. Most providers have developed referral habits over years, but they never had the data to understand the quality or cost of the care to which they were sending their patients. Today, in a value-based world, we can understand not only the costs to the patient, but also the quality of the service relative to cost, allowing provider groups to identify high-value specialists and facilities in their region. A robust referral-management system would rank according to these two factors in a way that is user-friendly and seamlessly integrated into a provider’s workflow.

Improving Clinical Outcomes

You can have a slick patient experience and get your patients to avoid care to lower costs, but if the clinical outcomes don’t follow, your patients end up worse off. That’s why delivering high-quality care for your patients is a “must do” in value-based care.

In my experience, providers typically grasp this concept the fastest. As highly trained clinicians, it’s what they were called to do — provide absolutely the best, evidence-based care to their patients. They intuitively understand the need for preventive medicine, care coordination, and taking care of their at-risk patients. It’s part of who they are.

That said, the best method to measure and document quality is a challenge. Unfortunately, the various and inconsistent ways in which payers measure quality can be a head-scratcher to clinicians. On top of that, the tedious methods required to track down and document quality care can be frustrating to an already busy provider.

That’s why, in value-based care, it’s critical to make it easier for providers to do what they already do well. You can do that by proactively getting patients in to see their doctor (such as for an Annual Wellness Visit), training the clinical staff to close gaps on their own, making it clear what quality gaps are outstanding within the point-of-care workflow, and repeatedly providing data on how they are performing relative to peers and goals.

Improving Clinician Experience

The final goal of the Quadruple Aim — the “Fourth Musketeer” as I like to call it — underscores and emphasizes all other goals. Without provider satisfaction and engagement, those other aims aren’t possible. At Privia, we like to say that “an engaged physician is the starting place for value-based care.”

At the same time, the system is working against our clinicians. I can’t describe what physician burnout feels like, but I do know that one of the common causes of burnout is decreased time with patients. In a joint survey from the American Academy of Family Physicians and CompHealth, 87 percent of providers said the best part of their job was “interacting with patients and helping patients.” However, fee-for-service models force providers to spend less time with patients, often addressing immediate needs but not underlying causes. The same survey found that 64 percent of providers responded that “excessive workload” was a leading cause of unhappiness. That is the end result of reimbursing providers for seeing more patients as opposed to delivering high-quality, meaningful care.

At the end of the day, this means that providers aren’t able to do what they were called to do.

Value-based care offers a way out. By reorienting incentives to focus on patient value (i.e., experience, cost, quality) instead of volume, providers are rewarded for providing great care to their patients. They can spend more time with their sickest patients without needing to “churn” through too many visits per day. Providers can demonstrate their own value as a clinician by the value their patients get out of the relationship.

Through value-based care, we can reconnect providers with why they went into medicine in the first place.

By overlaying the Quadruple Aim and goals of value-based care, we see a more defined picture of what the future of healthcare resembles for patients, providers, and other industry stakeholders. The more clearly we see this picture, the more clearly we see our next steps and what we must do to achieve the aims of these bold — but realistic — frameworks.

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