Four strategies for taking the risk out of value-based payments

While many in the healthcare industry believe value-based care is the future, they haven't necessarily been enthusiastic about jumping into it. 

That changed recently, however, with the U.S. Department of Health and Human Services’ (HHS) announcement of its goal of tying 50 percent of reimbursements by the Centers for Medicare and Medicaid Services (CMS) to quality or value through alternative payment models by 2018.  Given that CMS is the single largest healthcare payer in the U.S., this pronouncement provides the incentive to accelerate the transition. Most commercial payers are expected to follow suit.

That means it’s “go” time for providers and payers. Following are four ways to take risks out of the system and create a more successful transition to accepting value-based payments.

  1. Understand all the costs. For many health systems (especially those who want to become their own payers) one of the biggest risks is they don’t know what they don’t know. Obtaining these answers requires big data and a powerful analytics package. Incorporating data from other sources, such as claims data from payers, will provide a more complete view so health systems can negotiate value-based pricing with greater confidence. It will also give them a view of pricing outside of their own health system to further inform their approach. Using analytics to determine which physicians do the best job time after time, and then standardizing around their processes, procedures and the materials they use, reduces variation and eases the path to delivering value-based care. Implementing quality control and tight data governance helps ensure data is trusted, enabling value-based pricing to maximize outcomes, patient safety and revenue.
  2. Ensure real-time visibility into the entire care continuum. Once patients move from 24/7 hospital observation to the next level of care, their status is largely unknown. An investment in telehealth technologies can provide the needed real-time visibility to treat issues before they escalate. Population health data combined with real-time monitoring and incorporated into proscriptive analytics can spot trends even earlier, enabling smaller, non-intrusive interventions to be delivered in lower-cost settings.
  3. Make it easy for patients to become engaged. The risk of any procedure or care failing in the long-term goes up exponentially once patients leave a healthcare facility. That is why it’s important to ensure patients know what to do and are engaged in their own care. Care coordination has been identified as a key strategy to improving outcomes. Offering a concierge who will help patients navigate the complex healthcare system and follow the proper rehabilitation procedures is another approach gaining popularity.
  4. Manage the money well. Value-based arrangements tend to be very complex instruments. Health systems that lack experience in these complexities may want to seek out a partner that has the expertise and systems in place to handle these intricate machinations and keep the program on-track.

By following the strategies outlined here, health systems can move quickly to embrace the new realities and gain a significant competitive advantage – not just today but in the future as well.


About the authors:

Mike Lessila is Director of Business Development for SKYGEN USA, a world-class collection of benefit solution companies that bring together next-generation benefit management and technology tools that help healthcare organizations be market-leading and reform-ready.

Dirk Carson leads the Business Development efforts for Vestica Healthcare related to creating and administering value-based care and payment arrangements.