How Digital Transformation Can Accelerate Value‑Based Care
For the past 15 years, the healthcare ecosystem has been transitioning from a Fee-For-Service (FFS) model to a Value-Based Care (VBC) model. Aggressive goals by the CMS Innovation Center (CMMI) to have 100% of Medicare beneficiaries in an accountable relationship by 2030 puts greater emphasis on integrated care today. This has fueled the need for healthcare organizations to digitally transform at an enterprise level and across the healthcare ecosystem.
For VBC to work effectively at scale, organizations need to make a fundamental shift. Investing in digital transformation is at the heart of enabling VBC at scale. This shift requires healthcare organizations to put the patient at the center of the ecosystem and leverage digital platforms, solutions, and experiences to deploy more efficient, effective, and patient-centric care management across the healthcare ecosystem.
What is Value-Based Care?
VBC ties the amount health care providers earn for their services to the results they deliver for their patients, such as the quality, equity, and cost of care. Through financial incentives and an emphasis on integrated care, VBC programs aim to hold providers more accountable for improving patient outcomes while also giving them greater flexibility to deliver the right care at the right time.
While delivering high-quality care has always been providers’ primary motivation, previous payment models were not well aligned with this objective. Unlike the legacy FFS care model that compensates providers based on the number of services they deliver, VBC connects providers’ compensation to the health outcomes they deliver for patients. VBC payment models are designed to incentivize providers to focus on prevention, early intervention and care coordination to drive up quality and drive down costs.
It’s been 15 years since the first legislation was passed to begin moving healthcare providers from the existing FFS model to VBC. In the intervening years, healthcare providers, payers and CMS have piloted and adopted a wide range of alternative payment models aimed at delivering better care at lower cost.
Why is it important and what is it meant to achieve?
Healthcare organizations that aren’t actively moving to VBC systems risk becoming obsolete. Traditionally, they’ve been able to survive—but that is no longer going to fly in today’s world. Keeping existing cost structures and prices amid increasing transparency and decreasing reimbursement levels will be unsustainable. Organizations, whether large or small, community-based or academic, that excel in the value agenda will achieve financial stability and earn the most important reputation in healthcare—excellence in outcomes and pride in the benefit they provide.
The Centers for Medicare and Medicaid Services (CMS) has been at the forefront of VBC, aiming to move every Medicare FFS beneficiary and most Medicaid beneficiaries to care relationships with accountability for quality and total cost of care by 2030. The shift in focus requires whole-person care, which requires additional depth and scope of services offered by specialty care with effective coordination of primary and specialty care providers.
Individuals who receive VBC—such as through an Innovation Center model or through another program in Medicare or Medicaid—may notice enhancements to their health care experience. For example, they might have:
- An easier time navigating their care with the help of an assigned care coordinator who will contact them between medical visits to see how they are doing following a procedure, answer their questions, or problem-solve any issues they encounter following treatment.
- Access to training or other educational resources about their health issue(s).
- More options in terms of how they receive care or how to communicate with their providers.
- An opportunity to participate in a disease prevention program, such as for diabetes or heart disease.
Healthcare organizations must do what is necessary to achieve VBC in order to not be left behind.
How Do Providers Feel About VBC?
While 85% of provider groups believe that VBC will lead to improved patient outcomes—and 50% plan to move to a global risk model in the future—many practices are still experiencing challenges. The transition to VBC has taken longer and proven to be more challenging than expected. There is a need for more data, patient engagement and education programs, care coordination, provider staffing, and additional resources to accelerate the shift to VBC.
How Do Payers Feel About VBC?
Similarly, the largest commercial health insurers are investing in VBC programs to lower care costs and improve population health. Payers can provide the data, resources, payment structures, and incentives needed to drive quality improvement and ensure members receive the right care at the right time.
These strategies aim to align the interests of payers and providers to improve patient outcomes while controlling costs.
What is Needed to Accelerate the Move to VBC?
Six key elements are needed to accelerate the move to VBC:
- Organize Care Around Medical Conditions
Care delivery is organized around patients' medical conditions or segments of the population. - Measure Outcomes and Cost for Every Patient
Outcomes and cost are measured for every patient. - Align 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 patients. - Information Technology
An information technology system designed to support the major elements of the agenda.
How Can Digital Help?
Consolidate and Streamline Data
One of the primary obstacles in implementing VBC is the fragmentation of patient data across multiple systems, including electronic health records (EHRs), claims data, and patient-reported outcomes. This disparate information often leads to incomplete patient profiles and difficulties in measuring performance. Technology can help overcome this challenge by consolidating and streamlining data. Interoperable EHR systems and data integration platforms can help providers access comprehensive patient information in real-time. This enables more accurate tracking of patient outcomes, improved decision-making, and better identification of high-risk patients who require proactive intervention.
Establish Standardized Metrics
The lack of standardized metrics for measuring quality and outcomes can hinder the successful implementation of VBC. Without clear benchmarks, it is challenging to assess the effectiveness of interventions and identify areas for improvement. Advancements in data analytics and artificial intelligence (AI) can help address this issue by developing standardized metrics to evaluate care quality. By analyzing large amounts of data, AI algorithms can identify patterns and trends that reveal the most meaningful indicators of quality care. This can lead to the establishment of universally accepted benchmarks, enabling healthcare providers to compare their performance and make data-driven improvements.
Enhance Care Coordination
Effective communication and collaboration among healthcare professionals are critical for delivering VBC. However, traditional communication methods, such as phone calls and fax, can be time-consuming and inefficient. Healthcare technology can facilitate better care coordination through secure messaging platforms, telehealth solutions, and care management tools. These technologies can streamline communication, foster collaboration, and allow care teams to make well-informed, coordinated decisions. This, in turn, helps to reduce hospital readmissions, prevent medical errors, and improve patient outcomes.
Empower Patients with Digital Tools
Patient engagement plays a crucial role in VBC. When patients are actively involved in their care, they are more likely to adhere to treatment plans and achieve better outcomes. Technology can help empower patients by providing them with digital tools, such as mobile apps and wearables, that track their health status, monitor medication adherence, and offer personalized recommendations. These tools can also facilitate communication between patients and healthcare providers, enabling better care coordination and more informed decision-making.
Provide Powerful Content
According to the 2023 PatientPoint Patient Confidence Index, nearly half (48%) of Americans report feeling anxious before health care visits, up from from 39% in 2022. This anxiety is due to factors such as insufficient information and education, limited knowledge about health care providers, and hesitation to discuss health concerns with providers. Additionally, a third of Americans admit to regularly leaving appointments confused. Taken together, these anxieties hinder effective care. Asked about the factors that could enhance their confidence in discussing health matters with care providers, more than half (55%) of those surveyed highlighted the importance of receiving health education during appointments. In addition, 43% expressed interest in pre-visit education. Given that most patients spend approximately 14 minutes in the waiting room and an additional 12-13 minutes in the exam room without a healthcare provider (HCP) present, substantial opportunity exists to educate and empower patients while they wait.
Providers can maximize the value of time patients spend in their offices and support VBC by leveraging digital signage to disseminate relevant health information. Showcasing digital content in the waiting room prepares patients for important health care decision-making moments before they enter the exam room and has been proven to drive patient utilization of vital health services including mammography, colon cancer screening, flu vaccination, tobacco cessation counseling, and sexually transmitted infection screening.
The flexible environment of the exam room enables digital signage to deliver more tailored information to patients that further encourages them to talk to their provider and take proactive steps such as signing up for patient portals, scheduling preventive screenings and vaccinations, or discussing a new treatment.
The journey towards VBC is not just a shift in payment models but a comprehensive transformation of the healthcare ecosystem. Digital transformation stands as a pivotal enabler in this transition, offering the tools and platforms necessary to streamline data, establish standardized metrics, enhance care coordination, and empower patients. As healthcare organizations continue to navigate this complex landscape, the integration of digital solutions will be crucial in achieving the goals of VBC—improved patient outcomes, reduced costs, and a more efficient, patient-centric care model. By embracing these changes, healthcare providers can ensure they remain at the forefront of delivering high-quality care, ultimately leading to a more sustainable and effective healthcare system for all.
