From regulatory changes to technology advancements, there is a plethora of activity in the healthcare environment. Patients are becoming consumers. Data has to be even more safeguarded than usual. New players are creeping their way into the space.
And on top of that, providers are expected to transition to value-based care.
It’s enough to stress anyone out.
“I’ve never seen this much hitting us all at once,” Bruno Nardone, NextGen Healthcare’s senior vice president of population health solutions, said during the World Congress Integrated Delivery Systems Summit in Chicago last week. “People’s heads are on fire.”
Despite these myriad adjustments, the fact remains that shifting away from fee-for-service models is the way the industry is headed.
“Value-based care is the trend that’s rippling through the marketplace right now,” he added.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
From a macro level, this trend can seem large and daunting. But as Nardone demonstrated, value-based care is more of a continuum made up of three key horizons.
The first is the quality incentive frontier. As can be expected, this area is made up of organizations for which value-based care is still a fairly new phenomenon. They are slowly being incentivized to take on more risk.
The second horizon is the partial risk frontier. Organizations here have started utilizing models like bundled payments.
Finally, the third is the full risk frontier, which includes models such as global capitation. Systems sitting in this realm may even have their own health plan.
Though these horizons are neatly categorized, Nardone pointed out that the separation line isn’t so sharp in the real world. Organizations may be in more than one frontier or oscillate between them.
Fully achieving value-based care is not something that comes easily. For organizations looking to embrace such models, Nardone outlined six pillars of a comprehensive value-based infrastructure.
The first two are aggregation and analysis. “You need the right tools to make sure you’re capturing the right set of data to assess against,” he said.
The next pillar, care coordination and health improvement, is followed by the administrative and financial column.
Patient engagement is another crucial part of a solid infrastructure. “We have to be very mindful now that we have to find ways to engage patients outside the episode of care,” Nardone said.
The final pillar is clinical engagement. To gain success, physicians have to be on board with a value-based care strategy and be comfortable using any necessary tools.
As fee-for-service continues to melt away, healthcare organizations should create their own unique roadmap for achieving value-based care.
“You have to think about this along the lines of laying a foundation,” Nardone said.
Photo: Hong Li, Getty Images
