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Value-based Care

Value Based Care Challenges

Odds are, you decided to become a physician because you wanted to help people. So you went to medical school, and there you studied anatomy, physiology, and medical microbiology, among other subjects. You learned how to assess a patient’s condition and how to diagnose and treat. What medical school likely didn’t teach you was how to navigate the complicated realities of healthcare reimbursement. So you graduated and learned about that on the job. And just when you got used to fee-for-service reimbursement, the entire healthcare industry is shifting to value-based care and you have to learn all over again. This is particularly frustrating and concerning because if you don’t get reimbursed, not only are you not receiving your paycheck, but your practice could suffer.

Challenges of the Transition

A value-based care system is, by nature, completely different from the fee-for-service system you’re used to. In value-based care, providers receive reimbursement according to the quality of care they provide and the health outcomes their patients experience, typically being reimbursed episodically for each condition you treat for a patient, regardless of how many procedures you perform in treating that condition. Previously, in fee-for-service, each procedure or service you provided to your patient carried a specific fee. This stark difference in the two reimbursement models is exactly what makes the transition from one to the other so difficult.

According to Premier Inc., a healthcare improvement organization, there are very specific changes that must be made to the average medical practice in order to succeed in a value-based system, especially with regard to staffing. Value-based care is reliant on caring for the whole patient, and this requires the addition of staff such as behavioral health specialists, social workers, nutritionists, and pharmacist support. At the same time practices are incurring the expense of adding this additional staff, they’re also seeing the initial reduction in reimbursement that is an inherent growing pain in moving from being paid for every procedure completed and receiving one flat payment for treating a specific condition, regardless of the procedures performed.

This can cause an initial reduction in profits that can be concerning for practices that aren’t prepared. It’s important to note, though, that according to a 2018 KPMG poll, 46% of healthcare organizations were seeing an improvement in profitability through the use of value-based payment contracts, compared to 23% of organizations that reported improved profitability just two years prior. This means that the struggle of reduced revenue is temporary, and ultimately value-based care will bring financial benefits to your practice.

Success is Possible

The reality is that with a clear understanding that there may be some growing pains, but intentional steps to offset those challenges, success in value-based care is completely possible. The University of Southern California Price School of Public Policy reports that a Salt Lake City-based health system, Intermountain Healthcare, achieved its target of billing $700 million less by reducing the total care cost in 2016.

They did so by employing a number of techniques:
  • Implementing medical home primary care when needed
  • Identifying high-risk patients through medical data analysis and taking measures to help those specific patients to stay out of inpatient care
  • Handling complex cases in multi-specialty clinics for greater care coordination
  • Adding behavioral healthcare into the primary care plans of certain patients

Some of the most significant savings Intermountain saw came from the improved management of patients with high blood pressure and diabetes. They also saw strong outcomes from using nutrition and lifestyle coaching alongside pharmaceutical treatment. One of the biggest lessons that Intermountain learned was the importance of averaging costs to see success with value-based care. To an extent, this depends on the volume of patients, but consistently applying value-based principles to your entire patient population can help even smaller practices see success in this way.

Intentionality Equals Success

Making the transition to value-based care doesn’t have to be difficult, but it does require intentional planning and follow-through. One of the first things you’ll want to consider doing is changing your practice’s business model. More than likely, your current business model is based on fee-for-service reimbursement. However, if you’re going to succeed in value-based care, that business model simply isn’t compatible. If you continue on the way you’re going, the decrease of revenue during the transition is likely to be more dramatic than if you made the necessary changes to support value-based reimbursement. While you may still see some reduction in reimbursement, this will be temporary and should be less significant with the proper planning and changes in place, making the transition a less jarring one.

The next thing you should consider is hiring more staff. Remember, value-based care depends on quality of care and improvement in patient outcomes, and this is best achieved with staff in place to care for all of the patient’s health needs. Consider adding more nurses, behavioral health professionals, social workers, and pharmaceutical support, among others, to ensure that you’re caring for the full patient and meeting all their needs in order to see the best possible outcomes and the accompanying reimbursement.

MicroMD: The EHR for Value-Based Success

At Henry Schein MicroMD, we have an amazing solution to help your practice see value-based success. In order for an EHR to be useful for value-based reimbursement, it needs to have structured fields that are aligned with the reporting requirements of the various value-based payment models, as well as be able to efficiently extract and package that data for submission.

MicroMD fulfills this need by allowing users to seamlessly attest for over 60 quality measures right in our EHR. MicroMD also allows for risk stratification, care plan creation, and integration of all necessary functionality within the standard workflow, helping practices to be successful in minimizing costs by mitigating adverse events.

Finally, MicroMD offers a cloud-based solution, something that is particularly important with value-based care. This is because these payment models are still relatively new, and therefore still evolving. As changes come about, it’s best for a practice to have an EHR that can be quickly updated to stay in line with regulations and avoid hiccups in reimbursement. All of these features mean that you can rest assured with MicroMD that you will be able to achieve success in value-based reimbursement.

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Value-based Care Resources


Value-Based Care


What is Value-Based Care?


Healthcare Regulations: The Evolution of Value-based Care


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