It’s been a little more than 15 years since Michael Porter, Ph.D., a professor at Harvard Business School, published his book “Redefining Health Care Creating Value-Based Competition on Results.” Along with Elizabeth Teisberg, Ph.D., Porter introduced through his publication the term value-based healthcare system.
Also referred to as value-based care, it’s a care delivery model that prioritizes patient health outcomes in the way that health providers are reimbursed. A value-based care definition by the Centers for Medicare & Medicaid Services (CMS) as those that “reward health care providers with incentive payments for the quality of care they give to people with Medicare” and support the agency’s three-part aim of better care for individuals, better health for populations and lower cost.
Value-based reimbursements are calculated by using numerous measures of quality and determining the overall health of populations. According to the Institute for Strategy and Competitiveness (ISC), a nonprofit research and education organization founded by Porter and based at Harvard Business School, the six major elements necessary in a truly value-based system consist of:
- Organize Care Around Medical Conditions: Care delivery organized around patients’ medical conditions or segments of the population
- Measure Outcomes & Cost for Every Patient: Outcomes and cost measured for every patient
- Aligning Reimbursement with Value: Reimbursement models that reward both better outcomes and efficiency of care, such as bundled payments
- Systems Integration: Regional delivery of care organized around matching the correct provider, treatment and setting
- Geography of Care: National centers of excellence providing care for exceedingly complex patient care
- Information Technology: An information technology system designed to support the major elements of the agenda
Reduced Healthcare Costs and Other Perks
Although the concept of value-based care has been somewhat slow in coming to fruition throughout the healthcare industry, the use value of VBC payments is increasing due to policies such as MACRA, initiatives from the US Centers for Medicare and Medicaid Services Center for Medicare and Medicaid Innovation (CMMI) and state Medicaid programs. Since its inception, the CMII has launched numerous value-based payment models.
So why is value-based care important? Value-based care offers numerous advantages. Examples of value-based care health advantages include:
- Patients spend less money to achieve better health.
- Providers achieve efficiencies and greater patient satisfaction.
- Payers control costs and reduce risk.
- Suppliers align prices with patient health outcomes.
- Society becomes healthier while reducing overall healthcare spending.
In addition, value-based care models focus on helping patients recover from illnesses and injuries more quickly and to avoid the onset of chronic disease in the first place, resulting in fewer doctor’s visits, medical tests and procedures in addition to less money spent on prescription medications. By delivering proactive and preventative care, value-based healthcare systems can help ensure positive patient outcomes for their patients. Similarly, employing value-based care results in providers being reimbursed for the time it takes to coordinate care, an improved ability to address social determinants of health (SDOH) and an enhanced whole-person view of care.
Telehealth services are valuable tools to use in value-based reimbursement models that reward hospitals and health systems for lower utilization costs. Why? Because they reduce wait times and the cost of care, has the potential to improve other value-based care metrics and increase the Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores of providers.
Tips on Engaging Patients in Value-based Care
Preventive care is an integral component of value-based care, and healthcare providers and payers can utilize population health management to focus on it. Population health only improves when the health outcomes of many individuals improve, which is the primary goal of value-based care.
As value-based care reimbursement continues to become a reality for providers, many will adopt useful health IT tools that will improve their population health management efforts. Patient engagement platforms, specifically, consider the underlying factors that often inhibit people from practicing healthy habits, information from which communications and other outreach campaigns can be designed to motivate patients to take positive actions for their health.
Supplying the right tools and knowledge to high-risk patients can encourage them to take ownership of their care, which leads to better outcomes. Following are three ways to engage patients in value-based care:
Improve the Care Experience from Start to Finish
Patients with a value-based healthcare mindset are taking an active role in getting the care they want and deserve, so prioritizing the patient experience is a good place to start if you want to engage patients. Show you care by communicating with them in ways that are relevant and personalized to them. Whether it’s an appointment reminder that addresses them by name or a follow-up note after their appointment to check up on them, a personalized experience will help them feel cared for and engaged in their health.
Stay Connected Outside of the Clinical Setting
In a value-based healthcare model, it’s crucial that your patients take more control over their health. Being able to communicate and engage with them at every step of their journey through the care continuum increases the likelihood that they will improve adherence to care, thereby elevating outcomes and driving value-based healthcare at your practice. The right technology can even help you identify and segment patients based on specific criteria, such as condition, age or most recent visit date. Educational resources and message frequency can then be distributed to help improve compliance to care plans and proactively connect patients to the right resources at the right time.
Leverage Automated Technology to Scale Engagement
It’s unreasonable to expect your staff to manually call patients on a regular basis, but automated technology can help you deliver relevant and valuable messages at scale while still maintaining a personal touch. Also, by proactively engaging more patients, providers can increase the number of patients adhering to care plans, track key health metrics and reach out to their doctors when they have questions. Each of these behaviors can help patients improve their outcomes in a value-based healthcare model.
Find out how Providertech can assist healthcare providers and payers expand population health outreach, improving patient engagement and simplifying the transition to value-based care. Schedule a demo with us today!