3 Best Practices To Establish Clinicians As Value-Based Care Navigators

By Dr. Craigan Gray, CMO, Salient

The shift to Value-Based Care (VBC) has not been a seamless journey for the healthcare industry, specifically for providers. With a fast approaching CMS VBC deadline for 2018 and an industry-wide initiative towards population health, the time is now for healthcare organizations to make strides toward the future model with the help of quality-driven clinicians supported by accessible, easy-to-use analytics.

Clinicians, who are competitive by nature, can lead the charge towards this new model, streamlining strategies to deliver quality, cost-effective care throughout the healthcare system. One effective way to achieve the CMS mandated goals is to incorporate analytics into clinical practice. Here are three best practices to leverage analytics to address population health and bring organizations closer to VBC. 

Benchmark And Track Metrics
Establishing where the healthcare organization is clinically performing before engaging in population health is essential, especially when it comes to chronic conditions. The CDC reports chronic diseases account for 86 percent of the nation’s healthcare costs — that’s a huge sum of the overall healthcare spend.

Given the large percentage, chronic patients are a logical focus when beginning to engage and track towards population health management. The question is: what chronic conditions are driving high costs within individual organizations? Once the costliest diseases have been identified within a health system through the application of relevant analytics, the next step is to drill down into the following information:

• admissions and length of stay
• re-admission rates
• medication adherence

Specific claims and clinical data sets illustrate where physician teams stand with the clinical management of chronic diseases and enable them to create a strategy towards personalized care plans to treat these patients and thus have a greater opportunity to drive down costs with that population.

Bridge Gaps And Perform Improved Care
Once the healthcare organization has a benchmark on their clinical performance with specific chronic condition populations, the next step is to address areas of continuous improvement. According to a Workgroup for Electronic Data Interchange (WEDI) study, gaps in care management are essential to realizing the value of population health management.

This insightful data allows physicians to address issues that contribute to these gaps, such as patient engagement in their own care. Patient information will highlight where provider engagement can improve — whether it’s personally connecting on the phone to ensure patients are clear on their medication regimen to establishing a follow-up consultation to help them maintain and stabilize their condition. Analytics allow physicians to pre-identify and address specific clinical or social issues at the point of care that leads to a more personalized patient encounter. Together the patient and physician can then develop a care plan that will improve both the health of the individual and overall population long-term.

A Learning Tool
According to the Advisory Board, physician clinical care decisions drive 60 percent of the healthcare dollar. Not to mention, according to Agency for Healthcare Research and Quality (AHRQ), 87 percent of healthcare systems are using insights from analytics towards care quality reporting. Performance and measurement go hand in hand.

Understanding this impact, clinicians and their care teams need to engage with the analytics process early on and integrate it into their workflow. Analytics will enable them to identify areas where clinical improvement is needed and later lead to a clearer understanding of the overall impact within the organization. The insights derived throughout the chronic patient engagement plans are a guide and will highlight what’s working and what’s not — creating more clinically informed physicians who will lead the organization towards quality-driven outcomes and fair, stabilized professional reimbursement.

VBC has been discussed for more than 30 years within the industry and has, until now, been a distant goal. However, the healthcare industry is gaining real momentum and laying the building blocks needed to achieve the desired outcome. Clinical analytics is one of the important building blocks needed to achieve the goal — the triple aim — better population care, patient satisfaction and per capita cost. The journey towards value is not easy, but starting the transition toward the triple aim around physicians and analytics is a sensible and logical approach to successfully track and achieve VBC.