The Value in Shifting to a Value-Based Care Model

The pandemic has shown us that the fee-for-service model was just as fragile as we thought it was. Overnight, providers who had traditionally been reimbursed for the quantity of services provided (rather than better outcomes) found themselves in a devastating situation. 

The severe and sudden drop in office visits, without another strong source of revenue, has resulted in the temporary closure of practices or layoffs in order to stay afloat. Primary care physicians, in particular, have felt the greatest impact. It’s estimated that primary care practices will lose upwards of $15 billion in fee-for-service revenue in 2020 – a figure that does not yet account for the looming second wave of COVID-19. 

Primary Care Providers 

Despite research showing that the care they provide is associated with improved outcomes and lower costs, primary care physicians are among the most poorly compensated physicians. Although they serve as the backbone of the healthcare system, their most important role – to keep us healthy – is sorely overlooked and undervalued.

Primary care providers have known, more than anyone, just how untenable the fee-for-service model is. They have been working within and against a system that is firmly built upon a foundation that doesn’t align with value-based services, and instead rewards productivity with little to no concern for the outcome. 

The signs and symptoms clearly indicate just how sick our healthcare system has been for many years. All too common are the stories of providers who rise early in the morning to diligently complete loads of documentation, continue to work after dinner to return patient calls, and go to bed exhausted knowing that their work still isn’t finished. 

Shifting to Value-Based Care 

Before the pandemic, making the shift to value-based care was viewed, at best, as a “north star”, or, at worst, as a supplemental revenue stream. Many provider groups, health plans, and healthcare organizations have dipped a toe into the value-based world, but have struggled to dive in.

This is not necessarily due to a lack of desire to pursue a value-based model; but because navigating from fee-for-service revenue to an alternative payment model (APM) requires significant investment of time and resources. This investment is further exacerbated in that the transition process also tends to be messy and risky. 

At the end of the day, and after all of that work, the revenue will most likely continue to be tied to fee-for-service activities. For providers in particular, living with one foot in value-based care and one foot in the fee-for-service world still means living by productivity measures, which doesn’t get you very far from a value perspective, and can feel more like someone is piling on additional work. 

Anyone who has been on the frontlines of a practice or clinic understands that there is barely time to break for lunch, let alone time to address quality measures for an entire population or brainstorm on practice transformation. 

A Future with Value-Based Care

Value-based care should no longer be viewed as an unreachable north star, but rather as a way to navigate out of the mess we currently find ourselves in. The pandemic has created a tremendous sense of urgency to change the way care is provided. 

Primary care providers took a giant step by embracing and leveraging telehealth without skipping a beat, which has demonstrated that care delivered remotely is not only efficient, effective, and convenient, but is also remarkably well-received by those participating in it. 

There are many other things that can be made possible by our current situation to keep us moving on our journey toward “whole” value-based care, and they don’t have to be as seismic as telehealth. 

Consider these questions:

  • Has your practice seen any efficiencies gained by delivering care by phone or through remote video conference? 
  • Can that time (even as little as 30 minutes) be leveraged to identify what is most important to your practice? 
  • Can it be used to identify the pain points with your electronic medical records (EMRs)? 

You may be scratching your head and asking how simple things like this can push your practice closer to value-based care. The answer is simple—because these activities are value-based care. 

Conclusion

As the pandemic continues to change the way in which care must be provided, GHG’s subject matter experts stand ready to assist you in developing a value-based care strategy. Contact us to learn more.

Kate Rollins
Kate Rollins

Kate Rollins is Senior Vice President of Population Health & Clinical Innovations at Gorman Health Group (GHG). Kate's team is responsible for leading GHG’s efforts to define and advance the next generation of population health management and clinical innovation. Kate is a Clinical Nurse Specialist with expertise in oncology and infectious diseases, and a focus on caring for vulnerable populations. She brings over 20 years of experience in healthcare and health plan innovations to GHG, including clinical strategy development, program development, implementation, start up and ongoing operations, and performance management/evaluation.

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