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Value-based care: 4 tips to manage the switch

August 24, 2023 Article 4 min read
Tammy Schaeffer
Shifting to a value-based care model may be difficult in the short run, but you can expect long-term payoff for patients, providers, and your healthcare organization. Follow these tips for a successful transition.
Business consultant talking with a doctor about value-based care.The mere mention of a transition to value-based care can be stress-inducing for many leaders. Whether you’re an executive charged with organizational performance, a provider overseeing care for a complex or challenging population, or an operational leader trying to figure out what the future looks like for your operations, the changes can be daunting. These changes, though, are also better: Better for patients, better for care providers, and better for your organization and its bottom line. But this “better” doesn’t come without intentional and purposeful changes across your organization. If you’re just starting this journey, these four actions can help ensure your organization is set up for success in value-based care.

1. Shift your paradigm from volume to value

While market share is never a bad thing, organizations that continue to focus on inpatient and procedural volumes will struggle in the value-based arena. Instead, consider shifting the focus of your efforts to expansion and growth of service lines that align with ambulatory management, primary care, disease prevention, and chronic condition management.

If you’re wondering which direction your organization should take, asking some key questions may point you in the right direction:

  • What does the data show are your most frequently encountered diseases? 
  • Do you have well-deployed and embedded preventive and condition management services related to these diseases? 
  • Do you excel at managing chronic conditions in a way that promotes top decile outcomes without hospitalization? 
  • Is your ambulatory enterprise a well-oiled machine capable of seeing patients same or next day for any need? 

If you can’t respond with a resounding “yes” to any of these questions, consider a thorough independent assessment. Taking the time to identify the population and their needs, along with the right approaches, will pay significant dividends as you work to manage the health of a complex and challenging patient community.

Determine your organization’s readiness to transition to value-based care with a complimentary viewpoint 

2. Operations will make or break you

Your operations team is one of the most vital elements of your success in a value-based environment — and one that leaders often forget to consider. To succeed in a value-based context, your operations need to be honed to identify and manage chronic disease in a way that prevents progression of illness and promotes outpatient management of chronicity. Gone are the days when you could wait for patients to call when they needed to be seen. Value-based care requires operations that are streamlined to not only capture risk but to thrive on proactively managing it to improve overall health, promote effective diagnoses, and to drive great outcomes through efficient and cost-effective management.

3. Reimbursement is different, and you need to prepare

Reimbursement in the value-based arena is different, and it’s imperative that everyone throughout your organization understands it. Because payment is made on the expected cost of care, understanding and integrating the hierarchal condition coding system is critical to success. It’s also important to recognize that the hierarchal condition coding system isn’t just a payment mechanism, it also can drive outcomes of care through proactive identification of disease risk, diagnosis and management of chronic conditions, and minimizing condition progression and complications.

To ensure you’re appropriately paid for the care you provide, you not only need a mechanism to document the conditions but also the strategic analytics to help you see the sickest patients, appropriately capture their diagnoses, and effectively control utilization while still driving strong outcomes of care. To do this effectively, you need analytics at the provider level, and ideally on a weekly or monthly basis. Enlisting help to improve your accuracy and your analytics platform will help your team make rapid improvements to respond to patient needs and succeed in value-based measures.

4. Get your provider network on board

The shift from fee-for-service to value-based care requires a shift in the way you think about healthcare — not just for your organizational leaders but for every member of your provider network. Getting it right will require an adjustment of your culture, and that means supplying the infrastructure, education, and empowerment your people need to quickly adjust and succeed. Do they have the technology and tools they need to screen patients, accurately and completely diagnose issues, and provide the right treatment? Do they fully understand how the value-based care philosophy will help them create the best outcomes for their patient community? If you can create a supportive environment with strong guidance for your provider network, your chances of a successful transition will be much higher.

Get ready for better

Leaders are rightfully concerned about the transition to value-based care. These changes are no small task, but at their end is a financially sustainable system that’s better for everyone and is finally focused on health: health for the community, health for the caregivers, and health for your organization.

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