1) The Value-Based Care train has left the station.
Believe it or not, we are in the midst of a seismic shift from Fee for Service to Value-Based Care. In a Value-Based Care world, providers’ reimbursement depends on the outcomes and cost savings they deliver. Many doctors have already embraced risk-based contracts. Some are being rewarded handsomely for doing so. The top doctors in Premier ACO received $300,000 each in value-based incentive payments last year. The average incentive payment a Premier doctor received was $75,000.
Obviously, since this is healthcare, things are continuing to move slow. CMS previously announced that 50% of their payments in 2018 were going to be tied to value-based contracts. It is clear this will not happen. However, the time to prepare for the new world is now. Providers who do so will thrive. There are clear financial incentives for payers to adopt these new payment models. Ready or not, they’re coming.
2) Software will make or break success
It’s oft said that business moves at the speed of software. This rings particularly true for Value-Based Care. For providers to effectively manage their patients, they must understand how their patients are moving across the healthcare system, the relative risk level of each patient, and which patients will be most receptive to an intervention when. To pull this off claims data must be integrated with data from multiple EHRs and social determinant data. No small feat. It’s no wonder 87% of ACOs are losing money.
3) Data and software on their own are useless
You can have all of the data and the fanciest tech stack in the world, however, it’s entirely useless if people aren’t trained and incentivized to use it. Software must complement clinical workflows, not disrupt them. These workflows must be intentionally constructed so all parties are working at the top of their license. Data must be meaningful. Data must be visual. Data must be actionable.
4) Social Determinants Matter, arguably more than anything else.
An oft-overlooked part of patient care today is social determinant data. Does the patient have stable housing? How is their diet? Are their utilities turned on? You can give a diabetic patient all of the insulin in the world, but it won’t do anything for them if they don’t have working fridge to keep it in.
5) Value-based care will force us to move from “medical” care to “health” care.
The United States has one of the best “medical” care systems in the world. Our facilities and innovative surgeons are unmatched. However, we have one of the worst “health” care systems. Our incentives are structured so we all make more money when a patient stays sick.
This will change with value-based care. In order to succeed in value-based care, we must consider the whole patient. Some health systems are already going to churches and gun clubs to ensure their population is getting screened. Others are visiting patients and learning that their lack of power is leaving them in hundred degree heat which is driving their ER visits. Upon realizing this, they’re working with local governments to get the patient on the power grid.
Pretty cool, right?
We’ll dive into more specifics about what we learned in posts over the next few weeks. Follow along, and as always, feel free to reach out to us with questions.