Providers, health systems, and health plans across the country have been steeped in conversations about value-based care—and often the focus remains on the burdens and challenges of making the shift. We often hear about the difficulties of transitioning from fee-for-service to value-based care, and those concerns are valid. But, we also hear something else—that many organizations want to adopt new value-based care strategies but lack buy-in from stakeholders or don’t know when it will really be worth it to start the journey. It’s always easy to talk about the challenges associated with change, but what are the potential opportunity costs of not making the transition to value-based care?
Value-Based Care on the Rise
It’s no secret that investment in value-based care models is increasing. According to this McKinsey report, investment in value-based care quadrupled during the pandemic. Value-based care has significant momentum, even as stakeholders still define value-based care in multiple ways. Providers are incentivized to adopt value-based care strategies because they contain a promise of delivering higher quality care while reducing costs and increasing revenue. But, any major transition requires resources, attention, and a willingness to operate in the messy middle while moving toward fuller adoption—which is where many organizations get stuck.
Healthcare organizations face a series of interrelated challenges—which can also be viewed as correlated goals—when it comes to delivering better care that’s financially sustainable. In 2007, the Institute of Healthcare Improvement introduced the “Triple Aim” of improved patient experience, better outcomes, and lower costs. It has since evolved into a Quintuple Aim which spans patient experience, healthcare costs, population health, staff wellbeing, and health equity. These are the pillars of value-based care models, and successful adoption requires more than just vision, it requires an organization-wide action plan and ongoing leadership commitment.
Given these complexities, it’s easy to think of value-based care as a lofty goal, or something too big and abstract to pursue successfully. Changing the financial, clinical, and operational functions of your organization does carry risk, but there are also downsides to the status quo. So what are the opportunity costs of delaying the value-based care journey?
Risk #1: Money Left on the Table
Value-based care focuses on delivering efficient, high-quality healthcare that prioritizes patient outcomes. By not embracing this approach, healthcare organizations may squander the opportunity to optimize savings, enhance patient satisfaction, and increase revenue.
The number of value-based care programs available to providers continues to grow in the Medicare/Medicaid and commercial markets. Often, the key to success is aligning your organization's strengths with the program's objectives, which requires a deep understanding of the care model and targets you are signing up for as well as the data that indicates where your organization has the capacity and capabilities to impact the metrics of the program. The time is now to implement or enhance your population health tools and ensure your data is accurate so you can make well-informed decisions when it comes time to select the right value-based care models. As you begin to participate in more value-based care models, data and analytics need to be integrated into your care team’s workflows, offering actionable insights at the point of care and population level to identify opportunities for improved patient outcomes.
In a healthcare landscape where cost-effectiveness and patient satisfaction are paramount, dismissing value-based care is equivalent to bypassing an avenue for both financial gain and improved patient care. Just as leaving money on the table signifies lost opportunity, not embracing value-based care means leaving potential financial benefits and enhanced patient well-being untapped.
Risk #2: You’ll Have to do it Eventually—on Someone Else’s Terms
It may seem easier to think that value-based care isn’t something your organization needs to worry about in the near-term, but that would be a mistake. Value-based care isn’t going anywhere—and though financial incentives for adopting value-based care may be faster or slower depending on the Centers for Medicare and Medicaid (CMS), your state and other factors, the industry is moving in a new direction. Build your organization’s capacity to collect and analyze data, often across multiple EHRs, to effectively measure clinical quality and patient outcomes before the timeline is mandated for you.
Making proactive decisions about your data management and necessary workflow adjustments makes a lot more sense than having to move from zero to sixty when contractual pressure comes all at once. Start a journey toward value-based care on your own terms, because acceleration under pressure, such as a mandatory CMS Innovation Center model, creates patient, operational and financial risk.
In a recent study conducted by Azara in the Physician Practice market, more than half of respondents felt that being left out of contracts/falling behind the industry and negative financial impacts were the most common consequences of not pursuing value-based care.
Risk #3: Missed Care Opportunities that Lead to Suboptimal Patient Outcomes
Value-based care is centered around enhancing patient outcomes and experiences. Delaying the transition may lead to missed opportunities to provide patients with more effective, coordinated care. Under the traditional fee-for-service model, healthcare providers are incentivized to deliver more services, which can lead to unnecessary treatments and fragmented care. In contrast, value-based care directly aligns provider incentives with patient health. By focusing on preventive care, care coordination, and patient engagement, healthcare organizations can proactively address health issues and equity, reduce hospitalizations, and ultimately improve patient well-being.
Persisting with traditional fee-for-service models that prioritize quantity over quality poses a significant risk, potentially leading to suboptimal outcomes for both patients and communities. Conversely, value-based care programs incentivize identification and closure of care gaps, and emphasize the need to transition high-risk patients into comprehensive care management programs—effectively managing chronic conditions and reducing costs.
By shunning value-based care's incentives and data-driven strategies, the road to improved patient well-being becomes considerably more challenging. Adhering to outdated models not only jeopardizes patient care, it also stalls the progression of healthcare as a whole.
The Big Picture
At Azara, we partner with our clients to support and help them find success as more revenue is tied to value-based care models, knowing that regardless of the model, everyone has the same goal: find financially sustainable ways to improve people’s health. Too often, care teams don’t have the tools or resources they need to accomplish that goal. For organizations that are ready to start the journey toward value-based care on their own terms, the right data, quality measurement, and analytics solution are critical components of future success. Though the healthcare industry is so large and complex that it may seem impossible to change, many individual providers are moving the dial simply by getting started.
The overarching lesson here? Don’t let perfect be the enemy of good. No one expects a complete switch to value-based care overnight. But if you have a plan to move in that direction, and start putting the infrastructure in place now, you’ll be well-positioned to succeed in today and tomorrow’s healthcare economy.
It’s always more intuitive to consider the risks of something new, but there are risks to keeping things the old way too.
Want to learn how Azara can help your organization meet it’s population health and value-based care goals? Contact solutions@azarahealthcare.com or request a demo now.