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Doug Chaet, senior vice president, Provider Networks and Value-Based Solutions at Independence Blue Cross, shares five strategies that can help providers succeed in value-based reimbursement models.
ChaetValue-based reimbursement models are comprised of multiple stakeholders with differing agendas. While payers may be intent on bending the historical cost curve, hospitals and physicians are likely focused on incremental reimbursement and/or increased market share.
It is therefore critical that all parties share their respective “lens” and set expectations early on to ensure effective alignment down the road.
Gainsharing and risk-based programs can be overwhelming, especially when hospital/physician collaboration is at an early stage. Organizations should limit their initial focus to three to four indicators such as patient leakage, site-of-service rationalization, and emergency department utilization. Simple initiatives such as well-publicized extended office hours can significantly reduce non-emergent emergency department visits and start you on the road to success.
It is not uncommon for payers, hospitals, and other providers to tout the importance of physician engagement, but what does that really mean? Is a carefully crafted financial incentive program with periodic reporting really enough to get physicians to truly engage? The reality is that change doesn’t come easily and if evolving integrated delivery systems are serious about transforming physician behavior they need to commit to frequent and meaningful communication with their doctors. Bonus programs and comparative reporting can be useful, but at the end of the day, physicians need to clearly understand the difference between how they practice today, what you’re asking of them, and why it’s in the best interest of their patients (and their practice) to change the way they deliver care.
Population-based initiatives for specific diseases such as COPD can certainly be beneficial, but mature provider organizations have learned that their ability to effectively manage patients with multiple chronic conditions is typically what makes or breaks their performance in a risk-based program. Start by identifying the patients that comprise this population (e.g., more than six chronic conditions), establish a baseline for both cost and coordinated care, and then determine what your organization could have done differently from a care management perspective.
It can be difficult to accept, but if your value-based model isn’t disruptive it will, in all likelihood, not succeed. Most would agree that primary care physicians need to be re-engaged as the quarterbacks of care, historical referral relationships need to be scrutinized, specialist procedures need to be performed in the most appropriate setting, and the wide array of services offered by most hospitals need to be rationalized. The question is: How far are you willing to go in the name of value-based care? Pulling the trigger on initiatives such as these can be challenging, especially in a collegial setting. In the end, the best advice is to treat your value-based arrangements like a separate and distinct business. If you keep that in mind, you’ll do just fine.
Doug Chaet, a member of the Managed Healthcare Executive editorial advisory board, is senior vice president, Provider Networks and Value-Based Solutions at Independence Blue Cross, headquartered in Philadelphia.