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Christina Rosario

By: Christina Rosario on July 27th, 2017

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5 Steps for Transitioning to Value-Based Care

Value-Based Care

When you first entered the medical profession, patients typically were asked to make reimbursements for treatment under a fee-for-service system. That is a natural aspect of providing healthcare in a capitalist country like the United States, where the focus can sometimes be on profits rather than on achieving the highest standards of care.

Now there is a growing emphasis on value-based care. Essentially, we are talking about the difference between quantity of care (the more fees for services, the more profitable) and quality of care (patient-centered with less regard for reimbursement than for working toward better diagnosis, treatment, and outcomes).

With that in mind, here are five steps to help you transition to value-based care.

With so much information to deal with during the transition to value-based care, it can be difficult to keep up with all the details. Subscribe to our blog to stay informed and up-to-date.

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1. Identify Your Patient Population

Do you have a comprehensive idea of who your patients are? The demographics of the patients in your local area will affect how you deliver care, especially when focusing on value-based care instead of fee-for-service style care.

There is a treasure trove of information available to you when you deploy electronic health record or EHR software to keep the details straight for each patient. You can apply analytics to your patient population to uncover previously unseen patterns. For example, you might have a growing population of elderly patients, or are seeing a number of impoverished patients who have chronic problems that have been neglected for far too long.

Analytics can even influence the scope of your medical organization, showing you how many patients reside in various nearby ZIP codes. It might turn out that you should open a satellite office to better meet the needs of patients who are traveling farther than they’d prefer.

2. Form Partnerships with Organizations

Depending on the needs of your patient population, you may need to form some partnerships with related organizations.

For example, if you serve a large number of poor patients, they might find it difficult to arrange transportation for office visits and follow-up appointments. Work with a local community organization that provides free or discounted rides to the indigent and those who are unable to drive because of disability, illness, or injury.

If a member of your staff determines that patients are suffering from malnutrition, you should be able to immediately refer them to local aid agencies so they can get food stamps and access to a food pantry.

Can your patient read? An illiterate patient who cannot understand medication labels or wound care instructions will not have as good of an outcome as a patient who can understand what is required, after all.

3. Boost Your Investment in Staffing

In order to provide a higher standard of care to each of the patients you see, diagnose, and treat, it’s likely you’ll need to make substantial investments in your staffing levels.

Keep in mind that when you use specialized software in your organization, such as electronic health record and practice management applications, you will increase efficiency and speed up the flow of revenue in your office.

This means that with a proper technology and software system deployed, you can save money on administrative personnel and can divert funds toward hiring new physicians, nurses, and their assistants.

As the number of at-risk patients in your pool increases, it will cause you to need to step up your clinical staffing. There may be more patient involvement as you transition to a value-based approach. While fewer tests may be ordered (quality over quantity), the attention being paid to these test results will likely increase in a bid for improving patient care.

In addition to more physicians and medical assistants, you may be tasked with bringing in more case manager RNs, diabetes educators, nutritionists, genetic counselors, and so on.

4. Design Care Models

It’s crucial to start developing care models that are based on evidence and that your team will find easy to follow. Otherwise, the models may not meet your goals to improve the quality of care being delivered.

You’ll need to determine your current target population, figure out the payers that will be involved, and then come up with estimates of how the number of services might change and whether the volume will go up or down.

Begin by selecting the staff members who will first be involved in working with the new care model, and spell out what each nurse and doctor’s responsibilities will be. You should design new workflows that will meet your new objectives of quality over quantity in treating patients.

5. Define What Success Means for Your Organization and How You’ll Measure It

How can you deem that your organization is a success or not if you don’t first have a definition what success actually is? You’ll need to come up with a system to measure it too, so you can verify whether the team is meeting its goals.

Of vital importance is describing your medical organization’s value proposition for the purpose of showing that you are lowering the overall cost of care when compared to the high value of care you are providing.

Consider communication between your staff and the patients. Part of your design care model will have to do with how often you reach out to them by phone, email, or through messages via the online patient portal that you activate with your electronic health record software. You should also pay close attention to how often patients are visiting your practice (and how many no-shows occur each month).

Key Takeaway:

  • It’s time to get used to a new way of providing health care in the United States as we move from a fee-for-services model to system of value-based care.
  • You will need to get a better understanding of your patient population, which is achievable through analytics applied to your electronic health records data.
  • Forming partnerships with key technology partners will help smooth the way.
  • Chances are that you will need to invest more now to build up your staff to accommodate the requirements of value-based care.
  • To gain better control over your processes, you should design a care model.
  • The only way you can determine if your organization is a success or not is to have a definition of success along with a way to measure whether you have met its goals.

As the country moves from a fee-for-services model to a value-based care model, your medical organization needs to stay in the loop about health care industry issues. With so much information to deal with during the transition to value-based care, it can be difficult to keep up with all the details from government, industry, and academia. No matter how busy you are, you can stay informed by clicking here to subscribe to our blog.


About Christina Rosario

Christina Rosario is the Director of Sales and Marketing at Advanced Data Systems Corporation, a leading provider of healthcare IT solutions for medical practices and billing companies. When she's not helping ADS clients boost productivity and profitability, she can be found browsing travel websites, shopping in NYC, and spending time with her family.