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Achieving the ultimate healthcare outcome for your practice:  value-based care

The key questions to ask – and features to consider – to ensure your practice can achieve the promise of value-based care.


Value-based care — a term that has been all the buzz for the past few years as part of the push to reform healthcare in the U.S. — is much more like a mission than a buzzword. Achieving value-based care has become critical for practices and patients, especially as the market continues to evolve away from the fee-for-service model.

Today, there is already evidence that value-based care is making an impact. Consider the Triple Aim, an approach defined by the Institute for Healthcare Improvement (IHI) to optimize healthcare, which calls for improving population health and the patient experience while also reducing costs.

A survey conducted this year by ORC International showed that value-based care is responsible for reducing unnecessary medical costs by an average of 5.6 percent. A high percentage of payers also reported other significant improvements:

  • 80 percent — better care quality
  • 73 percent — increased patient engagement
  • 64 percent — improved provider relationships

The Stakes are High
At the heart of the move to value-based care model is the impact of chronic disease, which represents an estimated 85 percent of the annual healthcare spend. As patients bear a higher share of expenses and private and public payers react to rapid changes in clinical and demographic profiles, there has been tremendous pressure to shift from volume- to value-based payment systems. This means providers are reimbursed based on the quality of care and the ability to proactively address costly chronic conditions.

This transition presents two significant challenges for practices, both centered on population health. First, there is a fundamental philosophical change required. Second, practices must make significant investments in new technology, workflows and IT processes to meet the requirements of value-based care programs.

Finding Solutions to Support Value-Based Care Initiatives
With sometimes limited technical expertise, it can be difficult for practices to know where to start or what to look for as they consider making investments in the tools and solutions needed to support value-based care and population health initiatives.

Here are some key questions to ask – and features to consider – to ensure your practice can achieve the promise of value-based care:

  • Can we effectively share clinical information between practices? Accessibility of patient information between providers is the first step in addressing healthcare needs and developing coordinated care plans that will help patients minimize or eliminate the impact of chronic diseases. To support information sharing and interoperability, practices can benefit from adopting electronic health records, as well as new processes and technologies that encourage collaboration.
  • How can we analyze clinical and financial data? Look for administrative tools that enable you to coordinate care, collect reimbursements and capture required reporting data. For example, revenue cycle management services can help practices manage billing complexities and maximize payments. Depending on the program your practice is participating in, a payer could evaluate performance based on a set of quality measures, which are often process-oriented or based on clinical outcomes. For this reason, look for a tool that offers analytical capabilities, enabling you to identify vulnerable populations, assign a proactive care team, engage patients to improve outcomes, and reduce cost and utilization measures.
  • How can we manage care coordination and staff workflow to support population health initiatives? Practices should consider solutions that help them easily identify patients who are most in need of care to improve outcomes and minimize costs. It’s also imperative to identify any gaps in care. These activities could be something as simple as ensuring diabetic patients receive regular foot and eye exams. The solution also should enable staff to easily create and follow up on customized care plans that improve healthcare delivery and outcomes for patients, and that encourage health decisions between visits.

By adopting innovative solutions that address these features and offer robust capabilities, your practice can easily achieve the promise of value-based care. Technology today can (and should) provide a foundation for participating in many value-based programs, including Comprehensive, Primary Care Plus (CPC+), Patient-Centered Medical Home (PCMH), Merit-based Incentive Payment System (MIPS) and Accountable Care Organizations (ACOs), which incentivize better care for lower costs.

In addition, when using such technology, you can be assured you’re providing a high level of care to your patients, helping them manage chronic conditions and lead healthier lives. After all, this is the foundation for improving population health.

Photo: Hong Li, Getty Images

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