THINK TANK | Preparing For Value-Based Reimbursements

Under the banner of value-based care (VBC), federal officials have touted the “triple aim” as the effort to improve the quality of healthcare and health outcomes while bending the cost curve. The Herculean effort needed to achieve this will require regulators and purchasers of healthcare to move toward a value-based reimbursement (VBR) structure, which at its simplest terms means paying for quality over quantity. As a provider, this shift will affect you differently based on the state in which you live and work, your role within the healthcare service delivery world, and your readiness to adapt to necessary changes. This translates into a whole new world of service delivery and reimbursement structures. Primarily, it will require a shift from a traditional fee-for-service approach that rewards utilization, to one that is focused on a value-based payment structure rewarding outcomes.

Data and Value-Based Reimbursement: Quality Over Quantity

For most, this will require re-examining one’s role in the healthcare service delivery world. It will most often involve a redesign of how your agency delivers services and may require a renewed focus on the skillset and culture of your workforce. In my presentations, I often talk about using data strategically to assess how services are being delivered, how to identify gaps, address those gaps through enhanced collaboration, and also use internal data to develop an agency’s workforce to provide those services efficiently and effectively.

Depending on your perspective and your role in the field, I often hear two beliefs around the goals of a VBR structure in supporting the “triple aim.” In some circles I hear that there’s a sense that the increased administrative costs associated with setting up a VBR structure are greater than the savings that VBC hopes to achieve. Others point out that increased administrative costs required up front will be offset in the long-term by the savings that are going to be realized within a population-centric value-based structure. In reality, there is some validity to both schools of thought. The short term administrative costs may exceed initial savings that are going to be achieved, but in the long view, once the structures are in place, the ongoing savings to the healthcare system will be well worth the increased costs required up front to implement the structure to support VBR.

One of the most important principles of a VBR structure relies on an understanding of the needs and conditions of each individual, as well as the aggregation of needs and conditions across a population. Millions of dollars have already been spent to connect the healthcare industry electronically, including through the use of interoperability and HIEs. Today, many more providers are capturing utilization data and documenting services through electronic health records. Providers now have new tools with the ability to provide electronic prescriptions and states have health information exchanges. However, without consistent standards and commitment, we still have plenty of distance to cover to truly make a difference in population health and in addressing needs and conditions.

Preparing Your Agency For VBR

What can you, as a provider, do today to continue to align your service delivery to measure quality over quantity? To be successful, you will need to harness the power of your data and strategically use the information at your fingertips. This will equip you with the ability to quickly adapt to a value-based approach of providing services. Need some tips? I was recently joined on a webinar by members of the Foothold community who represent agencies preparing for VBC. Hear some of the ideas they provided by listening to a replay of our conversation and learn how an electronic record, like AWARDS, can assist you.