Five ways to prepare for value-based care today

September 25, 2019
Joshua Claman, MBA
Joshua Claman, MBA

Many physicians do not feel equipped for being able to deal with the issue of readying themselves for a value-based, outcome focused world.

Profit is an incredible motive to drive innovation, but it can also create a misalignment in incentives within healthcare. If incentives encourage more encounters and procedures rather than the prevention and proactive management of disease, not only do costs increase, but patient outcomes do not improve. In an environment in which around 70% of U.S. healthcare costs can be attributed to chronic disease, and six in 10 adults have at least one chronic condition, the time has come to approach this issue with a radically new perspective.

Many physicians do not feel equipped for being able to deal with the issue of readying themselves for a value-based, outcome focused world. However, when Adam Boehler, the director of the Center for Medicare and Medicaid Innovation (CMMI), states he wants to “blow up fee for service,” it’s clear the train has left the station. Quality, not quantity, will be the key driver of success going forward, and profit will be maximized by focusing on outcomes.

Encouraging policy changes that make value-based care relevant today

We can all agree on at least two pillars of quality-based care: 1) Bringing healthcare to where the patient lives, which makes sense economically, drives higher patient satisfaction, and improves patient adherence and engagement; and 2) making use of all the data surrounding the patient, which is key in not only holistically caring for that patient, but in also driving better population outcomes.

In the last year, the Centers for Medicare and Medicaid (CMS) has made it clear that it intends to double down on these areas. Two notable changes from 2018 are the addition of new reimbursement codes for remote patient monitoring, and the renaming of Meaningful Use to Promoting Interoperability.

Remote patient monitoring specifically refers to the use of digital connected health devices to collect patient data in the context of their daily lives and securely send it to their doctors. Armed with a more complete picture of their patients’ health, clinicians can monitor real-time key biometrics of the patient, driving continuous communication, virtual encouragement and changes in treatment plans, while avoiding expensive – and for the patient, inconvenient – ER visits and unnecessary and costly readmissions.

Data interoperability is key to allowing data to move from the EHR to other applications and platforms, which drives optionality, improves holistic views of the patient, and results in better population and clinical analytics. Encouraging EHR and other innovative technology providers to play nice with one another, and nudging them away from extortionate data exchange fees, is a step in the right direction.

So, what steps can your organization take to prepare for value-based care today?

1.     Virtualize your clinic. Use connected devices and remote monitoring to better understand your patients’ health and to improve patient engagement and adherence. Make sure that the devices used require minimal interaction with the patient, and that the data goes to a place where it is actionable and integrates with current workflows.

2.     Connect data to action. Many population health platforms and data-driven programs are well-meaning, but can add to the growing physician burnout epidemic. Data uncovers a problem or gap in care, but unless the data is connected to action, clinicians can feel burdened rather than empowered. Assure the data you provide your clinicians is actionable within their existing workflow.

3.     Move to a care team approach. Enable all members of the care team to practice at the top of licensure – MAs, Pas, clinical pharmacists. Begin with advocates, and create triage paths for high-risk patients to therapy management teams.

4.     Align physicians with your goals. While value-based incentives at the organization-level are starting to gain steam, many healthcare leaders note there needs to be significant compensation plan changes at the individual physician level for value-based care to truly take hold. To change individual physician behavior, the compensation tied to that behavior needs to be material for the individual – usually at least 20% of their total compensation. The way the compensation payment is calculated needs to be clear and simple.

5.Explore EHR-integrated technologies. With FHIR interoperability standard API, third-party technologies can turn data you have from the EHR into a powerful tool for better patient outcomes. Take some time to research third-party apps that work within your existing EHR.  

Joshua Claman is the CEO ofRimidi, a cloud-based software platform that enables personalized management of chronic cardiometabolic conditions across populations. He has over 25 years leading technology businesses in Asia, Europe and the Americas. His industry experiences span his time in Dell in several senior executive positions, including the founding and development of Dell’s European Healthcare business, to his role as president of ReachLocal, one of the largest advertising technology companies in the U.S., and serving as the chief business officer of Stratasys, a leader in 3D printing in the medical field. Josh is a strong advocate for the promise of technology.