The Time Is Right to Revisit Value-Based Care

Article

Although alternative payment models have been around for a while, they have never been more necessary.

It has been nearly two years since the start of the pandemic, and the changes to health care delivery during this time have been significant. Providers across all specialties have had to continuously adapt the ways they offer care to ensure their patients keep receiving the services they need, when they need them. This has involved ramping up and sustaining telemedicine capabilities; continuing preventive services despite fluctuating case numbers and staffing shortages; rethinking crisis communications to keep people abreast of changing protocols; and attending to social determinants of health (SDOH) that can limit timely access to care.

Rohit K. Kashyap

Rohit K. Kashyap

Amid all this change, one thing has become increasingly clear: Traditional fee-for-service arrangements fall short in a crisis because they limit a practice’s ability to provide non-traditional services that yield more responsive, high-quality, cost-effective care.

In contrast, value-based care arrangements can offer greater flexibility. Some of the practices that have embraced the alternative payment models (APMs) have had an easier time navigating the pandemic. They have seen steadier revenue throughout the crisis. Given that the Center for Medicare & Medicaid Innovation (the Innovation Center) is currently looking to increase participation in APMs, healthcare providers may want to consider these more accommodating arrangements going forward.

As a founding partner of IKP Family Medicine in Houston, a group practice that is affiliated with the Renaissance Physicians Independent Physician Association, I have seen firsthand the benefits of APM participation for our providers, patients and the wider Houston community. From my perspective, the advantages fall into three main categories.

1. A better patient experience.

More people are managing complex medical conditions than ever before. To do this well, they or their loved ones often must coordinate information between multiple doctors and nurses, which can be time-consuming, confusing, and frustrating. Waiting to hear back from one doctor before speaking to another can also cause care delays, which can have negative impacts on health outcomes. When patients are expected to understand what one provider recommends and then communicate that information to another one, they may fail to share key details correctly, increasing risk even further.

With an IPA, however, there is a multispecialty team of doctors and nurses who are committed to creating and evolving individualized care plans based on the latest patient information. The IPA assumes responsibility for care coordination, freeing patients to focus on their health and giving them peace of mind that their care is being managed appropriately and effectively.

With an IPA’s broad network of physicians, patients also have more timely access to routine procedures because there are more available appointments. This combination of easy access and seamless care coordination can yield a more positive patient experience in terms of both health outcomes and satisfaction.

2. A stronger commitment to preventive care.

Disease prevention is a key tenet of value-based care. Providers that participate in an APM commit to following evidence-based practices for screening, diagnosis, treatment, and long-term condition management. The result is that patients tend to have better health outcomes at lower costs. For example, in 2020, our physician practice was able to complete more screenings and reliably deliver more preventive care than other practices in our area, despite people’s hesitancy to visit doctors’ offices for wellness care.

Over the course of the year, per our quality metrics, we completed 11% more colorectal screenings, 10% more breast cancer screenings, and 10% more diabetic eye screenings as compared to our peers. As a result of these and other proactive strategies, our patients had fewer hospital admissions and readmissions. We also improved our STAR ratings substantially.

3. Greater adaptability

The monthly reimbursement that organizations receive from more advanced APM contracts offers a steady, dependable revenue stream that evens out revenue cycle ups and downs. Our IPA is engaged in some fully capitated payment models, which reduces financial fears. Providers now have the ability to treat patients in ways not typically reimbursed by payers. Using these models, providers can pay for things like telehealth programs, patient outreach initiatives and SDOH interventions.

These processes not only set current APM contracts up for success. They help with future APM contracts as well.

At IKP Family Medicine, we are able to leverage similar processes throughout alternative models before they even transition to value-based. For example, we use the same templates for each of our annual wellness exams, regardless of payer or contract. This allows us to create a more streamlined approach to care, ensuring our patients’ data is captured through traditional models in a way that enables for a more seamless transition to the more advanced APM models. This ability to plan ahead allows for success throughout the transition to value-based care.

All in all, these processes give you the adaptability necessary to achieve greater health outcomes.

Seize the moment

Although alternative payment models have been around for a while, they have never been more necessary.

When practices affiliate with an entity like an ACO or IPA and are able to engage in capitated payment models, it allows them to create a culture and implement processes that put patients first and give providers the power to respond to change, the result is more targeted, efficient, and patient-centered care, even during a crisis.

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