The writing has been on the wall for years: the shift away from fee for service to value-based pay is coming. Recently that message, now in bold type, proliferated to every healthcare media outlet, to every ACO and provider bulletin board and every board member’s inbox.
As much as 30 percent of Medicare payments could come in the form of value over volume through the likes of ACOs, bundled payments and other quality-metric payments by 2016 under a new proposal by Health and Human Services, with the goal of possibly reaching 50 percent by 2018.
The move represents perhaps the most palpable shift away from the fee-for-services model that has dominated in healthcare for years and which has been cited by scores of health experts as a pervasive disincentive to coordinated, value-driven care.
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In light of this acceleration to value-based pay, here are three things the entire continuum, including Medicare providers and ACOs should be doing right now.
1. Use the longest lever available to affect avoidable costs and improve outcomes at the same time.
In the medication and pharmaceutical realm, this means reducing avoidable costs due to non-adherence. Research from the IMS Institute of Healthcare Informatics indicates total avoidable costs in U.S. healthcare amount to $213.2 billion. Nearly half of those avoidable costs are attributed to medication non-adherence: $105.4 billion.
According to the National Institutes of Health, fifty percent of Americans exhibit non-adherence to their medication regimens and according to a 2011 Consumer Reports survey of 660 primary care physicians thirty percent never get their prescriptions filled. Fixing this has significant requirements, but it is entirely possible to take a massive bite out of $105B in avoidable costs to the benefit of all concerned.
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As we learned last year, enhanced medication therapy management has the capacity to significantly reduce readmissions in the Medicare population. There are $2.7B Medicare dollars waiting to be saved by implementing medication therapy management.
2. Ensure EMRs are being utilized effectively to the benefit of patient outcomes.
All the data in every EMR in existence is useless unless it’s being utilized to improve outcomes. Develop process maps and SOPs on how to utilize these systems for continuity and methodology. Compiling and protecting data is necessary, but it must be accessible by the right players in the continuum of care who can utilize and act on it quickly. If an mHealth device shows a patient’s blood pressure is skyrocketing while at home, isn’t connected to an EMR and provides no alert to a care team member capable of acting on it, the preventative opportunity is lost, potential savings are lost and the patient becomes acute.
3. Define value and commit to tracking patient outcomes.
We define “value” as outcomes divided by costs. If affecting the top line of the “value” equation where value equals outcomes divided by costs is not on your next board or team meeting agenda, put it there.
“Patient-centricity” has achieved buzzword status. What does it really mean? How often are patients seeing physicians and clinicians (in a hospital setting, clinical setting or primary care setting) and being sent out the door with just a pat on the back? Implement better patient engagement or better yet “patient empowerment” methodologies and track outcomes metrics. We know that for chronically ill patients, the most difficult and costly to treat patient engagement means medication reconciliation, education on why, when and how to take their medications and more to yield successful outcomes. We track medication adherence through multiple metrics because we know with great certainty that is what is required to improve outcomes.
The shift to value-based care is going to force a shift in providers’ mindset, team function, partner selection and patient engagement outside of the hospital or physician’s office. Those that actively manage this shift, select and hold accountable the most closely aligned, capable partners focused on proving their abilities to improve patient outcomes first and foremost will be the winners.
[Photo from Flickr user Kevin Krejci]
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