A successful transition to value-based care requires real change. Providers are expected to manage populations, make better use of team-based care, measure outcomes and empower patients to take better care of themselves. Change of this magnitude is hard. It won’t happen without effective leadership and new systems of care. But a combination of old and new strategies can help organizations transition to value-based care while improving patient health and reducing overall costs.
Making the change
If you are part of a provider network, you are probably looking to develop the skills and infrastructure required for valued-based contracts. You understand that changing from fee-for-service to fee-for-value will be daunting. Hip replacements and other elective surgeries — currently a rich source of fee-for-service income — will become costly episodes for patients covered by value-based contracts. On the other hand, patients with chronic conditions, who account for the lion’s share of total medical expense for your population, will offer a major opportunity to manage costs in the future. In this topsy-turvy world, yesterday’s cost centers become tomorrow’s income centers (chronic care) and vice versa (elective surgery).
Let’s assume you have the vision, personnel and a plan to educate and involve your clinical leaders in this undertaking. Let’s also assume you appreciate the need to draw patients to your accountable care organization by becoming their medical home. You now need tools that let you take on population management without burdening your already overstretched clinical staff.
Strategies to consider
You know that culture change does not happen easily. What to do? Are there natural allies with proven products in the marketplace who can help? Here are three ideas:
- Expand primary care by using existing community-based providers. You want to build your primary care base but are constrained by the shortage of primary care physicians and the capital needed to start new practices. Consider partnering with existing convenient-care, urgent-care and pharmacy providers. These providers have matured, expanded their scope of services and are rapidly reaching scale across the country by offering convenient, less-expensive care in many of the neighborhoods you serve. Most insurers cover this care, and patients are voting for it with their feet. Pharmacies have expanded their services beyond convenient care and immunizations to medication management and chronic-care coaching. Improving medication adherence alone could make a huge difference to your financial well-being and help patients stay healthier. The good news is that care delivered in these settings is less expensive, is of high quality and can be tightly integrated into your network.
- Plan to manage your population. For many years, health plans have embraced population health management programs to control costs and improve care. These programs, focused on the chronically ill, offer health coaching to help patients take better care of themselves. They have resulted in less use of emergency departments and fewer hospitalizations. Today, these services provide analytic and reporting capabilities that give you a view of the various segments of your population and provide you with management-level detail on cost, utilization and disease progression. More-advanced programs have also incorporated shared decision-making, a decades-old strategy that is back in vogue, as well as programs that identify patients who will soon require expensive care, such as prediabetics and prehypertensives.Population health management tools are also being used at the provider level. In my experience, care management interventions prescribed by the provider are more effective than those used by health plans: Provider-based programs are far more effective in patient selection and patient engagement. They also produce more-attractive returns on investment.
- Use telehealth and other web and telephonic services. Telehealth is coming, and you need to be there. Minor medical emergencies are often amenable to the convenience of a computer-based visit. Episodes that require more can be directed to convenient, urgent or PCP care. Online scheduling can direct patients to the right care setting, help patients make appointments within your network and result in increased loyalty. The result is better service at a lower cost as well as care kept in your network. Every day, your patients are on the web looking for health care information on diagnosis, treatment, diet and more. Helping them use evidence-based tools and find providers in your network makes great sense. Nurse lines are inexpensive and effective in helping patients find the right care in the right setting and avoiding unnecessary use of the emergency department.
Combining old and new
All of these solutions expand your ability to care for more primary care patients at a lower cost. None require recruiting new PCPs or building new office space. All exist today and have proven returns on investment. Your patients will be using these services — with or without you.
We all want tomorrow’s care network to offer more patient-centric, affordable care. Exploring these new partnerships may well help you on your journey to that desirable future.
Peter Goldbach, M.D., is the chief medical officer of RediClinic and Health Dialog in Boston.