Important considerations for primary care practices in the shift to value-based care
By Sherri Onyiego, MD, PhD, FAAFP
Today, primary care physicians are constantly on the move keeping pace with jam-packed daily schedules and facing ongoing challenges including an expanding panel, patient satisfaction/retention, reduced reimbursement, the moving target of industry mandates governing billing, coding, and documentation, and a host of pressures contributing to burnout.
With everything on their plate, adopting and adapting to value-based care, and the transition from traditional fee-for-service models to value-based contracting can be especially daunting. For those practices treating underserved populations with often the most complex patients, this is even more true.
So far, practices report that documentation and data collection required under traditional value-based contracts are creating a strain on practice resources. Practice leaders also have concerns around clarity on quality measurement, and target setting for shared cost savings, which might mean they won’t be paid fairly for their performance. Plus, they often cite concern that managing value-based contracts will pose a distraction from day-to-day patient care.
Change is challenging and the concerns are valid, but with transformation also comes opportunity including achieving the ‘quintuple aim’ in health care: enhancing patient experience, improving population health, reducing costs, boosting the clinician experience, and addressing health equity.
We all know VBC isn’t going away. According to CMS, all Medicare payments and the vast majority of Medicaid payments will be governed by value-based contracts by 2030.
So, we all need to officially join this movement. As we do so, let’s remember we aren’t going it alone – it’s a collaborative and collective effort. An important key to making the shift is knowing what you can do, what you cannot, where to focus, and who to team up with to get the right support.
Here are five important considerations for primary care practices to ensure success in their shift to VBC.
Reimbursement
Any value-based incentive program should be structured with achievable, predictable, and transparent financial incentives. Shared savings design can be an important part, but it shouldn’t be the only part, especially if you’re a small, independent PCP. You can’t wait for the payer to send you one big check eight months after the end of the year. Financial incentives are important to improving quality and costs. Somewhat like the fee-for-service payment, there must be a more immediate and direct link between work done and payment received. Look for a VBC program that delivers more regular payment advances on shared savings to the practice based on the work completed.
Transitions of Care
Transitions of Care are essential to bridging the gap between health care settings (i.e., from hospitalization to the home). It includes coordination and continuity of care as a patient transitions between those settings. Successful Transitions of Care interventions improve quality of life for patients hospitalized with acute conditions. Reducing costly acute care encounters is also critical for VBC success. Transitions of Care are opportunities for PCPs to bridge the gap between the ER and hospital to home by ensuring continuity of care is achieved. Industry evidence shows that completing post-discharge follow-up visits within seven days of discharge is a proven means of reducing the further chances of ER returns and hospital readmission, two things that we all know drive up overall health care costs.
High-Risk Member Management
It may sound obvious, but it’s crucial to prioritize a scheduling focus on the sickest patients – the ones taking themselves to the emergency room or bouncing in and out of the hospital and never really addressing their health needs. For optimal success in value-based contracts and to generate shared savings, it’s important to prioritize the members who are most at risk of hospitalization.
Focus on Non-Medical Drivers of Health (NDoH)
Factors such as access to secure housing and healthy food, as well as reliable transportation which impacts access to medical care all play a significant role in determining health outcomes. As practices move across the value-based continuum, it is important to become a resource for patients to help remove the barriers to health faced by many underserved and low-income populations. To account for NDoH, clinicians should survey patients using appropriately vetted and validated assessment tools to uncover the challenges they face. The information collected can then be analyzed to uncover common trends among various patient populations. Finally, armed with information on their patient needs, clinicians can begin to connect patients with the community-based organizations that can help them address those challenges.
Technology
Research by Equality Health revealed that the average PCP had 12 different Managed Care Organization contracts, with most requiring documentation in a payer-specific portal. Inputting data into 12 different portals is unmanageable for an independent PCP. A more viable and sustainable solution is a single platform to house all documentation to all payers, as well as a streamlined process for value-based workflows that connects to and pulls from the EMR so that providers and staff inputting patient data are not duplicating workload. Independent PCPs are an important engine of change in VBC – they are the first point in a patient’s care journey and a crucial resource. For the underserved populations, that’s even more true.
So, transitioning to VBC is a must. By keeping an eye on the basics, understanding the limitations of internal resources, and enlisting collaboration partners to help, independent practices can make the shift with less burden and burnout, achieve all five aims, while maintaining a healthy patient panel and a fiscally fit practice.
Afterall, our collective success in VBC benefits everybody: individuals, communities, payers, clinicians, and the overall U.S. health system.
Sherri Onyiego, MD, PhD, FAAFP, is Medical Director for Texas at Equality Health, a company offering a set of services to help independent primary care practices deploy a whole-person care model and adopt and deliver VBC for diverse and historically underserved communities. The company is leading the transformation toward VBC delivery with population-specific programs that improve access, quality, and patient trust. The firm offers technology, care coordination, hands-on support to practices, as well as bears financial risk to optimize practice performance under the new VBC payment model.