Now is the time to revisit value-based care

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While alternative payment models have been around for a while, they have never been more needed.

It has been almost two years since the start of the pandemic, and the changes to the delivery of health care during that time have been significant. Providers in all specialties have had to continuously adapt the way they deliver care to ensure that their patients continue to receive the services they need, when they need them. This has involved increasing and maintaining telemedicine capabilities; the continuation of preventive services despite the fluctuation in the number of cases and the shortage of staff; rethinking crisis communications to keep people up to date with evolving protocols; and taking into account the social determinants of health (DSOH) which can limit access to timely care.

Amid all of these changes, one thing has become increasingly clear: Traditional fee-for-service agreements are insufficient in a crisis because they limit a firm’s ability to deliver non-traditional services that deliver more responsive, high-quality and cost-effective care.

In contrast, value-based care arrangements can offer greater flexibility. Some of the practices that have adopted alternative payment models (APMs) have found it easier to navigate the pandemic. They saw more stable incomes throughout the crisis. Given that the Center for Medicare & Medicaid Innovation (the Innovation Center) is currently seeking to increase participation in APMs, health care providers may wish to consider these more accommodating arrangements in the future.

As a founding partner of IKP Family Medicine in Houston, a group practice affiliated with the Renaissance Physicians Independent Physician Association, I have seen first-hand the benefits of participating in APM for our providers, patients and the greater Houston community. From my perspective, the benefits fall into three main categories.

1. Better patient experience.

More people are manage complex medical conditions than ever before. To do this well, they or their loved ones often have to coordinate information between multiple doctors and nurses, which can be time consuming, confusing and frustrating. Waiting to hear from one doctor before talking to another can also lead to delays in care, which can have negative effects on health outcomes. When patients are expected to understand what one provider is recommending and then communicate that information to another, they may not properly share key details, further increasing the risk.

With an API, however, there is a multispecialty team of doctors and nurses who are committed to creating and evolving individualized care plans based on the latest patient information. The IPA takes responsibility for the coordination of care, which allows patients to focus on their health and ensure that their care is managed appropriately and effectively.

With an API’s vast network of physicians, patients also have faster access to routine procedures as there are more appointments available. This combination of easy access and seamless coordination of care can lead to a more positive patient experience in terms of both health outcomes and satisfaction.

2. A stronger commitment to preventive care.

Disease prevention is a key principle of values-based care. Providers who participate in CPA are committed to following evidence-based practices for the screening, diagnosis, treatment, and management of long-term conditions. The result is that patients tend to have better health outcomes at lower cost. For example, in 2020 our medical practice was able to perform more screenings and reliably provide more preventive care than other practices in our region, despite the reluctance of people to visit doctors’ offices for medical treatment. well-being.

During the year, according to our quality measures, we performed 11% more colorectal screens, 10% more breast cancer screens and 10% more diabetic eye screens compared to our peers. Thanks to these and other proactive strategies, our patients have had fewer hospital admissions and readmissions. We have also significantly improved our STAR ratings.

3. Greater adaptability

The monthly repayment that organizations receive from more advanced APM contracts provides a stable and reliable revenue stream that even out the ups and downs of the revenue cycle. Our API is engaged in some fully captured payment models, reducing financial worries. Providers now have the ability to treat patients in a way that is typically not reimbursed by payers. Using these models, providers can pay for things like telehealth programs, patient awareness initiatives, and SDOH interventions.

These processes do not only prepare current APM contracts for success. They also help with future APM contracts.

At IKP Family Medicine, we are able to harness similar processes through alternative models even before they transition to value-based models. For example, we use the same templates for each of our annual wellness reviews, regardless of payer or contract. This allows us to create a more streamlined approach to care, ensuring that our patient data is captured through traditional models in a way that allows for a more seamless transition to more advanced APM models. This ability to plan ahead enables success throughout the transition to value-based care.

Overall, these processes give you the adaptability you need to achieve better health outcomes.

Seize the moment

While alternative payment models have been around for a while, they have never been more needed.

When firms are affiliated with an entity such as an ACO or IPA and are able to engage in capitation payment models, it allows them to create a culture and implement processes that prioritize patients and empower providers to respond to change, the result is more focused, effective and patient-centered care, even in times of crisis.

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