Healthcare News & Insights

Value-based care is here to stay: Keys to surviving & thriving

Value-based care is the future of health care. Despite the recent fluctuations in the industry caused by government changes and debates over the Affordable Care Act, there’s no going back to a reimbursement system based solely on services provided to patients. 

Experts say that fee-for-service care will never completely disappear, but with the growing pressure on hospitals and other healthcare providers to take a more complete approach, value-based care will be the primary focus.

Because the healthcare industry is moving toward a model where hospitals are at greater financial risk based on patient outcomes, facilities must be ready to to embrace behavioral changes designed to improve care at lower costs.

Stay principled

As healthcare facilities take on the brave new world of value-based care, there are four principles they must follow, according to Joseph Antos, a scholar at the American Enterprise Institute think tank.

Those principles are:

  1. Change your mindset. Hospitals should be focusing on providing top-notch healthcare services for patients – without excess or waste. Though fee-for-service won’t entirely disappear, its reign is ending, so put your energy toward providing high-quality, cost-efficient care for patients.
  2. Integrate care delivery. Hospitals should no longer act in isolation. Facilities and providers are part of a complex, cooperative ecosystem. Realizing this, and acting accordingly, allows for the best possible patient care.
  3. Measure cost and outcomes for patients and make big data work. Using big data to measure outcomes sounds complicated. But it’s not as overwhelming as you may think, especially since most patients have smartphones and other personal devices that track health information providers can analyze to improve care delivery.
  4. Make “doing the right thing” worth the effort for patients, providers and payors. Telling people to take actions now that’ll make them healthier later doesn’t work well because people aren’t always thinking about the future. Figure out ways to show patients the immediate positive results of keeping themselves healthy.

Take cues from kids

Children’s hospitals are exempt from most federal mandates that regulate value-based care, like the value-based purchasing program and bundled payments.

Despite that, most children’s facilities are adopting value-based reimbursement principles because they think this approach is best for patients and their own financial success.

Several elements need to be put into place before your organization can truly shift to value-based care, said Tim Robinson, the executive vice president for Nationwide Children’s Hospital in Ohio.

Preparations for value-based care include having:

  • an infrastructure that uses data analytics
  • care coordination capabilities
  • a culture that enables wellness and prevention
  • a holistic view of patients and family, and
  • pharmacy engagement.

However, not all value-based care is the same. Hospitals in different geographic regions and markets will all have their own unique factors to consider when making the transition.

Depending on your state’s insurance plans and legal requirements, as well as your patient mix, additional challenges may arise. Knowing how to respond to them is essential to providing excellent value-based care.

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