In the past decade, the value-based care (VBC) movement has transitioned from a passive evolution focused on learning opportunities into an industry imperative. The permanence of VBC is now apparent, but many are still struggling to make a return on their investment (ROI) in value.
COVID-19 negatively impacted 53% of value-based arrangements;1 however, the strategic importance of VBC initiatives has never been more evident. While 89% of executives believe their organization needs to engage in more value-based arrangements, nearly half don’t feel their organization is capable of executing value-based strategies.2 Despite the aspirations of many organizations to implement accountable care, competing organizational priorities, misaligned payment mechanisms, and delayed ROI lead to inequality between an organization’s capabilities and its strategic needs. Leaders are juggling these challenges while facing some of the worst margin pressures in recent history. To succeed, healthcare providers must overcome these obstacles and incorporate value into their strategic, operational, and financial planning to become true Value-Centric Enterprises.
Path Forward
A Value-Centric Enterprise is an organization that places equitable and appropriate patient care at the center of its operating model. It utilizes clinical, financial, and patient experience data to prioritize the delivery of VBC and to drive strategic, operational, and financial planning decisions. Our communities are demanding healthcare that focuses on compassionate and positive physician-patient interactions. The transition from fee-for-service (FFS) to VBC is not an easy one; however, the organizations that have already succeeded have shown us that it is not only possible but imperative for the long-term success of the healthcare industry and the well-being of the communities we serve. At Forvis Mazars, we have assisted many organizations through this transition and recommend organizations build upon the following:
- Accelerate innovation across the care continuum to include investing in tools to manage total cost of care for your community. Leveraging data analytics, advanced technology, and population health management approaches allows organizations to gain insights into cost drivers, identify areas of inefficiency, and implement targeted interventions to optimize resource utilization. These tools enable healthcare organizations to track and analyze data related to clinical outcomes, utilization patterns, and cost variations, which can inform decision making and drive initiatives for cost containment and value creation across the care continuum.
- Generate physician buy-in when implementing value-based arrangements through clinical empowerment and accountability. Giving physicians a sense of ownership and influence over decision-making processes related to VBC can be achieved by involving physicians in the design and implementation of value-based arrangements and actively engaging them in the decision-making process. When included in the planning process, a physician’s expertise and perspectives can shape the program to better align with clinical workflows and patient needs. Other aspects of clinical empowerment are fostering a culture of collaboration and interdisciplinary teamwork in addition to providing physicians with the necessary tools, resources, and training to succeed in VBC. Achieve accountability by establishing clear performance metrics, benchmarks, and quality standards that physicians are expected to meet in tandem with regular performance feedback and performance-based incentives.
- Provide clinical and administrative teams with technology, tools, and data to better care for patients, regardless of the setting. Access to actionable information enables healthcare professionals to make informed decisions, streamline workflows, and enhance care coordination. Key tools may include:
- Electronic medical record optimization
- Clinical decision support systems
- Data analytics and reporting
- Care coordination and communication platforms
- Population health management tools
- Performance dashboards and reporting
- Patient engagement tools
The availability of comprehensive and timely information supports evidence-based practice, collaboration, and informed decision making, ultimately leading to better patient care and satisfaction.
By honing focus within these areas, leaders will help improve care in their communities and reap the benefits across all VBC contracts, agnostic of the payor.
Outcomes
Focusing on the abovementioned areas has driven meaningful clinical and financial results for healthcare organizations. One large nonprofit healthcare system’s first step was creating infrastructure to manage patient populations and utilization. They then created a population health services organization (PHSO), bringing together administrators and physicians to provide care management, risk adjustment, data analytics, and other functions needed to execute their VBC strategy successfully.
A nonprofit academic medical center, early in establishing its accountable care organization (ACO), empowered primary care physicians to lead the charge by placing them at the center of the VBC conversation while leaning on innovative technology to better understand patient acuity and population health using Forvis Mazars’ data analytics toolkit.
Both organizations emphasized the importance of including physicians in risk-based contracting conversations, empowering them to drive contracting terms so that cost-reducing objectives do not impede their ability to deliver higher-quality care. Both organizations aligned incentives and made incremental changes that ultimately led to the successful implementation of a Value-Centric Enterprise.
Conclusion
The transition to value-based models is rapidly occurring. Looking to the future of VBC, healthcare organizations need to establish value-based arrangements with a strategy focused on compassion, innovation, clinical empowerment, and accountability. By preparing now, organizations will be better positioned to reap long-term rewards as they resume becoming a Value-Centric Enterprise.
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- 1MINDSETS: Forvis Mazars Executive Leadership Survey Results, forvis.com, November 2021.
- 2MINDSETS: Forvis Mazars Executive Leadership Survey Results, forvis.com, November 2021.