From Value-Based Care Goals To Realities: 4 Steps To Your Desired Destination

By Clyde Wesp, Jr., MD, MAOM, Executive Clinical Strategist, Jacobus Consulting

It’s one thing to have a destination circled on a map, quite another to actually get there and put your feet on the ground.

Case in point: Health and Human Services (HHS) has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations or bundled payment arrangements by the end of 2016. HHS is also aiming to tie 50 percent of payments to these models by the end of 2018.

With such a clearly defined landing, the fact that healthcare is moving toward value-based care is indisputable. The big challenge heading into 2016 and beyond, then, lies in figuring out exactly how healthcare organizations will achieve this ambitious goal — and that’s where thinking needs to move outside the box. Following are four innovative steps healthcare organizations can take to succeed under these emerging value-based care models.

1. Develop and use non-traditional metrics. With value-based care models, healthcare organizations will be paid based upon the quality — not the quantity — of services delivered. The challenge inherent in moving in this direction, however, rests in establishing models that equitably reimburse providers and, at the same time, elicit the desired clinical care outcomes. Healthcare organizations need to move beyond using indicators for traditional metrics such as mortality and infection rates which measure the level of “sickness” in a population. Instead, care providers need to rely on metrics that look at populations such as decreases in obesity and type 2 diabetes or increases in the number of people who reach their step goal on their wearable fitness tracker — adding insight into the level of community wellness.
2. Break down barriers to data. The healthcare industry no longer needs to concentrate on information technology adoption, as the majority of clinicians across the country seem to have accepted computers as a vital patient care tool. The challenge now, however, rests in optimally sharing and leveraging the data that emanates from these systems. In short, the right information needs to get to the right clinician at the right time. Clinicians also need to access relevant data about the patient they are treating and can’t be overwhelmed with reams of data during each patient encounter. On a broader scale, organizations need to be able to tap into data for risk adjustment and stratification enabling them to target their attention and services to the patients and populations that need it most.
3. Concentrate on changing behaviors to truly move toward healthier populations. While it’s important to have the most effective treatments, infection control programs, and preventative vaccines in place, it is becoming ever more important to focus on the social determinants of health such as inactivity, obesity, and healthy eating and encourage behavior changes that will result in improved health. As such, healthcare organizations need to put programs in place that make it possible for patients to adopt healthy lifestyles. Such behavior change is an imperative if organizations want to improve outcomes. Remember, the first evidence that smoking is harmful to your health emerged in the 1960s — but knowledge wasn’t enough. It took a community of players to influence smoking cessation and prevention programs and ultimately help change individual and group behavior.
4. Bring unconventional community players into the fray. Improving population health cannot be achieved single-handedly by healthcare executives and organizations. Instead, health providers must work with a wide array of community players, many of whom are not often thought of in terms of healthcare. For example, a city planner could have a significant impact on the health of a community. To fight obesity, for instance, adequate walking and biking paths need to exist for safe activity. The head of the chamber of commerce can have an impact by attracting grocery stores that sell fresh produce into certain areas. As such, communities could abolish the food deserts, where people only have access to unhealthy fast food.

By leveraging these innovative strategies, healthcare organizations can move beyond simply defining where they want to be in terms of improved clinical outcomes. They can actually get there — and experience success under emerging value-based care models.

About the author
Dr. Wesp currently serves as Executive Clinical Strategist for Jacobus Consulting, a leading healthcare consulting firm, based in Irvine, CA. and adjunct professor at USC Sol Price School of Public Policy. Dr. Wesp is dedicated to improving the quality and safety of patient care through clinical decision support, evidence-based medicine, and the transformation of operational processes. Dr. Wesp graduated from Rutgers University-NJ Medical School, completed residency at Children’s Hospital Los Angeles, holds a Master’s degree in Organizational Management, and is a lifetime member of the American Association for Physician Leadership. For more information on Jacobus Consulting, go to www.jacobusconsulting.com.