Las Vegas, NV - “If a sector-wide transformation to value-based care is going to be successful then providers must be put in the driver’s seat and be supported from all angles. It’s as simple as that.” Jeb Dunkelberger, VP Clinical & Commercial Operations, ACO Partner, stated to attendees at the 2016 Annual National Institute (ANI) conference for Healthcare Financial Management Association (HFMA).
As the healthcare industry transitions to this new-age of reimbursement dominated by value-based payment models, providers who wish to succeed need more than just a technology platform, a team of care coordinators, or a consultancy. Today, providers need an end-to-end synchronized care delivery platform, which allows for tailored fitting to their currently used technologies.
This type of care delivery platform allows for the patient to be the ignition key to create customized care plans, interventions, and analytics for that patient. And to be successful, these care delivery platforms must be supported by payer contracts that incentivize high-quality services and preventative interventions.
At ACO Partner, Jeb has seen first-hand in Arizona how value-based services organizations can help drive new care delivery platforms and create additional value for patients and providers. To work effectively, a customized approach must be built for each group of providers, be it a solo practitioner, or a multi-specialty group of hundreds. “We are in the business of coordination, efficiency, and protecting autonomy – there is no one-size-fits-all mentality for what we do, and we take pride in that, we take the time to know our providers and our patients because our model is built around them.”
During his presentation at the ANI conference, Jeb discussed how to create viable risk-based models and then focused on the quintessential pieces needed to create a care delivery model that’s capable of succeeding in today’s value-based reimbursement contracts.
Six Major Characteristics of Successful Care Delivery Models
Workflow neutral solutions. Presuming the practice is operating efficiently, the goal of transforming a practice’s day-to-day workflow should be for the net impact to be as close to neutral as possible.
Little to no upfront cost. Through use of multi-payer approaches and reengineering of reimbursement methods, providers and services companies need to approach with little to no upfront cost and use shared savings and risk to create their profit margins.
Predictive analytics leading to preventative interventions. Any organization which wishes to be sustainable and self-sufficient must start moving towards data-driven decisions on efficacious preventative interventions allowing them to succeed in different types of value-based contracts.
Data-driven referral and prescription programs. Understanding where an organization can derive value from is not always easy in healthcare. In terms of increasing quality and decreasing avoidable costs, there is no question that using high quality specialists and assisting patients with medication regimes, poly-pharmaceutical reviews, and generic substitutions can provide near-term recognizable results.
Capability and resources to coordinate care along the continuum of care. Having the purview and resources to manage patients across the continuum of care is one of the most difficult tasks in today’s healthcare space. That said, this must be a core strategy for any organization that wishes to be solvent as reimbursement continues to shift to value-based.
Creating the right incentives. An organization must create reimbursement structures and professional incentives that support reduction in low-value or unnecessary interventions. One cannot create a value-based organization with a purely fee-for-service model, it must ensure they are rewarded for outreach and prevention, and balance the transition in reimbursement methodology.
“Value-based care is no longer a ‘what if’ or a ‘when’ but rather a ‘how’. Healthcare organizations today must act, they must change, they must innovate, or they will place the solvency and stability of their business at risk.”