How Health Systems Are Driving the Volume-to-Value Transition

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Many health system leaders — myself included — are no longer wondering if value-based care models will take hold, but rather how we can ensure a seamless transition. Health systems play a pivotal role in the volume-to-value shift as we serve a high volume of patient-customers.

As COVID-19 has made clear, value-based care is a key element of not only success, but also resiliency, helping to offset the sharp, immediate decrease in patient volume. Jacqueline LaPointe, writing for RevCycleIntelligence, reported: “Alternative payment models that use population-based payments to incent providers to deliver coordinated, high quality, person-centered care are key to building healthcare system resiliency after a crisis like COVID-19.”

Health systems can develop resiliency and improve performance by using technology to both engage customers and gather important data so that we can refine our operations and further advance value-based care.

Technology as a Tool, Service, and Value Driver

Healthcare has many technological tools — telehealth, patient portals, electronic health records (EHRs) — designed to improve the customer experience and increase engagement. These widely adopted tools have benefits to health systems as well. For example, deploying telehealth can engage physicians, improve communication, and increase the number of patient visits, thereby increasing revenue. Patient portals can close care gaps and, by reminding patients of appointments, reduce the number of costly no-shows. EHRs support alignment by ensuring a seamless delivery of data at the point of care to improve care coordination.

Technology can also drive value for health systems by gathering actionable data and quality measures. As Clay Holderman reported for Managed Healthcare Executive, “Health systems have tremendous value savings sitting in the data trove of electronic [health] records.” To collect on this value, health systems can “slice the data to create patient-member cohorts with similar risk profiles, diagnoses, or utilization patterns and design care models accordingly.” Properly segmenting data can identify and prevent customers from expensive encounters, such as an unnecessary emergency department (ED) visit, thus increasing savings in value-based contracts. Furthermore, the data housed in EHRs can be used to demonstrate quality measures to payers, thereby increasing reimbursements from alternative payment models.

Talent to Support Operations

While these technology tools can benefit both customers and health systems, if not implemented appropriately, they can fail to deliver results, add costs, and create confusion. An analysis of health systems by Definitive Healthcare noted: “If patient data is inaccessible to providers, it is essentially useless in terms of care coordination and preventative medicine.” Among survey respondents, “lack of resources” was cited as the leading barrier to value-based care.

What resources are lacking? Certainly staffing and insufficient IT or technology, as the survey noted, but also — and one could argue, most importantly — talent and expertise. Health systems can benefit greatly from finding a vendor or partner with experience in turning data analytics into actionable steps. This expertise drives consistency, repeatability, and scalability of workflows, metrics, and outcomes. The right partner can help health systems better segment patient-customers, as noted earlier, close care gaps, improve documentation, risk adjustment, and quality, navigate shifting policies and regulations, much more.

Finding Your Partner for Alignment

However, even the “best” partner may not work for your health system if it doesn’t align with your mission and goals. As I’ve discussed before, alignment — clinically, financially, culturally — is the linchpin for success in value-based care. In addition to alignment, a partner can help health systems educate, train, and engage physicians to encourage them to re-imagine their role through a value-based care lens.

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