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Perspectives on Value-Based Care Shift

Posted by Matt Breese on Oct 4, 2016

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Hospitals and individual medical practices are quickly learning that the old standard of being paid for the volume of healthcare services they provide is being replaced by a value-based model.

A shift in thinking

No longer are payers willing to reimburse healthcare providers for additional, sometimes cautionary tests, readmissions or even extra, out-of-the-norm follow-up care. Rather, payers are more frequently using evidence-based benchmarks to determine the total scope of services required to provide a patient the best possible outcome for a particular procedure or visit. They set payments based on that equation and expect providers to perform accordingly. Hospitals and practices receive a flat fee for benchmarked services regardless of the services they actually provide or who provides them.

It’s a wake-up call for many organizations that operate in an industry that can just as easily be characterized by unexpected outcomes as it can by standards and benchmarks. Healthcare is both science and an art. Each patient is unique and each patient’s condition can go south in a heartbeat despite receiving the best and safest care. While every physician hopes for the best outcome for each of his or her patients, even the best standardized practices and protocols will not always avoid every potential pitfall.

Leveraging technology

Hospitals and practices must embrace technology in order to survive this transformation. Technology can support clinical best practices, as well as supply-chain, operations and revenue-cycle requirements.

The electronic health record (EHR) may not have been the most popular technology when it was first launched, but it has rapidly become the savior for providers who must manage patients across the care continuum. An EHR houses critical clinical information, and provides demographics that support population-based care. An EHR can trigger alerts, improve case management and promote quality initiatives. It is also an essential communication tool for clinical partners and affiliates who share responsibility for a patient’s care. What some perceived as burdensome technology and a time-consuming intrusion into the exam room is now indispensable.

Revenue-cycle and supply-chain technology support C-suite decision making and across-the-organization operational success. Leveraging technology to streamline processes, administer staffing, track performance indicators, manage cost accounting and accounts payable, and effectively and efficiently control resources gives organizations insight into the life-blood of day-to-day operations and oversight of elements that can quickly turn profit margins into losses.

The advent of telemedicine 

Telemedicine, through telephonic and video conferencing and specialized devices, is another form of technology that will help healthcare organizations transition from the fee-for-service to the value-based model. Although telemedicine can’t solve all healthcare-delivery problems, it does address key concerns. It can improve access to care, facilitate patient-provider relationships and help providers manage on-going care, especially for patients with chronic conditions. In essence, telemedicine is fundamental to meeting the Institute for Healthcare Improvement (IHI) Triple Aim of:

  1. Improving the patient-care experience
  2. Improving the health of populations
  3. Reducing the per capita costs of healthcare

With the advent of telemedicine, patients can receive effective initial evaluations and/or follow-up care, regardless of where they live, and access to subspecialty care can be made available to populations that do not have expansive local healthcare services. For example, neurologists can use telemedicine to perform initial neurological examinations with the assistance of the patient’s local primary-care provider, thus avoiding what might be a long trip to a specialist. Or, they can work with emergency room staff to evaluate a stroke patient and begin administering life-saving tissue plasminogen activator (tPA) before transporting the patient to a specialized stroke center. Patients with pacemakers or implanted defibrillators can be remotely monitored and cardiologists can recommend interventions when needed. EEGs and radiographs taken in a small, rural community can be read by specialists in a regional medical center that may be miles away. There are even devices that monitor whether patients are taking their medications. The list of examples of how telemedicine technology can facilitate patient-focused, cost-efficient care and quality patient-provider interactions is nearly limitless.

Technology alone can be cold and impersonal. When integrated into clinical care, however, technology can support organizational effectiveness and resource utilization, improve patient the patient experience, and help hospitals and practices successfully transition from the “do more” model to a value-based model, so they are properly and appropriately reimbursed for the quality care they provide.


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Topics: Industry Trends, Provider