For three days at the end of October and beginning of November, health practitioners, population health professionals, and healthcare technology experts from around the nation converged on Washington, DC for the America’s Physician Group (APG) Annual Fall Conference. One of the biggest topics of discussion was the transition to value-based care. Presenters and participants shared their experiences with value-based care, the challenges they are facing, and strategies to succeed in this transformative era of healthcare. Here are our three key takeaways from all of these thoughtful discussions on value-based care:
Opportunities in Value-Based Care Expanding for All
Primary care providers act as vital gatekeepers in the healthcare system, assuming a crucial role in continuous care management, population health strategies, and optimized referrals. These responsibilities align with the objectives of value-based care, rendering primary care a central component of value-based models and approaches developed thus far.
But stakeholders are progressively exploring avenues to expand value-based care to specialty care, and the expansion is gaining momentum through increasing penetration in episode-based models by multiple specialties including nephrology and orthopedics. Health systems are increasingly exploring innovative ways to achieve seamless collaboration between primary and specialty care services to drive patient-centered care through cost-effective measures.
Current and future value-based care models are being developed to serve diverse populations and health systems, from small or rural health care organizations—where human, technological, and financial resources may be limited—to large organizations that are experienced in integrated care and moving towards sustained growth.
Collaboration and Partnerships Enable Success
Even though provider interest in value-based care models remains high, participation is contingent on risk appetite, which is built through improved outcomes and efficient cost management. Both require data-driven decision-making to track patient outcomes, manage populations, and enhance care coordination.
Small practices and new participants in value-based care models might find it difficult to build the required infrastructure and capabilities quickly. Hence collaboration with existing platforms and established vendors can help accelerate goal realization, or at the minimum, identify system deficiencies that need to be addressed and improved.
To enable person-centered care that is paramount to achieving desired goals in accountable care, organizations need to ensure seamless integration and data sharing between different care providers, from primary care physicians to specialists, as well as community health organizations that can help address social determinants of health and inform care coordination and decision-making.
Payer-provider collaboration is equally important as payers can share meaningful data to help assess the effectiveness of interventions, reduce barriers to care access, and highlight opportunities to lower costs. A unified data-sharing strategy and process across payer and provider systems informs and improves provider performance and patient outcomes.
Member Risk Scores Becoming Increasingly Important
In value-based care systems, providers are rewarded for achieving better patient outcomes and reducing costs. Both require a complete and accurate picture of patients’ health. Risk adjustment helps in accurately identifying patients’ full disease burden with substantiated data and documentation. This ensures that accountable care organizations have appropriate resources to deliver effective and high-quality care to the members they serve.
In addition, risk models are crucial to understanding beneficiary alignment and incentivization. While prospective risk models are thought to place more weight on chronic conditions that influence expenditures over multiple time periods, concurrent models place more weight on acute care needs. ACO REACH became the first program to implement social risk-related payments that were based on a composite measure of the Area Deprivation Index and dual status. With CMS’ commitment to advancing equity through value-based care and the success of the ACO REACH program in program year 2022, we can expect social-risk related payments to become more prevalent.