Here we are in 2017, with subsidies being cut, access to care being threatened, and a looming question of “…what does the future of value-based transformation hold and how should health systems position themselves?”
Let’s remind ourselves, this journey of value-based transformation reached new heights of attention, and adoption, with the passage of the Affordable Care Act (ACA). Before the ACA, which most now refer to as Obamacare, pockets of capitated payment models existed, but were, and still are limited. Now, all health systems are being asked (if not, forced) to venture into risk-based arrangements with varying levels of infrastructure to successfully manage the health of their community.
Before diving into value-based transformation, it is essential to understand the underlying lever: money. Specifically, how the dollars flow. This notion of value-based transformation leaves behind the comfortable world of fee-for-service (volume) reimbursement and moves us into a place where reimbursement is aligned with outcomes. Value-based arrangements require an organization to share in the responsibility (risk) of achieving the Triple-Aim; improving the experience of care, improving the health of populations, and reducing per capita costs of health care.
To do this successfully, health systems must assess their capability to manage their community, not only the one within in their hospital walls, but to actually create points of meaningful connectivity and influence within the daily lives of their community members. Here are six ways to do that:
- Take responsibility for your population.
Health systems are often the longstanding employer of the community and have an ability, and obligation, to lead the community to health beyond the delivery of scientifically proven acute care. Take advantage of being a cornerstone of the community and convene and educate your fellow municipal and business leaders to develop and commit to a culture of community health. As healthcare professionals, we are quick to extract ourselves out of the equation. Remember, we are all patients. Every single one of us. Why don’t we own the experiences we create in our own communities?
- Build relationships that instill trust by meeting your community where they are.
For many of us, long gone are the days of bumping into your primary care physician at the grocery store and as a result, health systems are seeking relevance in their member’s lives. Health systems must extend and build relationships to meet their members in their daily routes; both physical settings (barber shops and churches) and online communities. Online communities are real and only gaining traction. In 2014, the average U.S. consumer spent 40 minutes on Facebook. In 2015, it jumped to 50 minutes. Invest in a social media strategy.
- Transform your workforce to match your desired capabilities.
Evaluating the alignment between human capital investments and desired outcomes is a starting place. When I first joined naviHealth (a care transitions company that offers post-acute care management and a large convener for Bundled Payments) in 2013, I was not meeting Vice Presidents of Post-Acute Care within the hospital setting. By 2015, I was not only meeting Vice Presidents of Post-Acute, but also Vice Presidents of Population Health, both being employed by the hospital. Health systems must dedicate fulltime positions and employees to engage and building meaningful relationships with post-acute care providers and community-based organizations.
Once these new positions are established, aligning compensation to the outcomes across the organization will drive the adoption of standard care processes. There are ways for physicians to be financially rewarded based on the savings accrued. And, let’s not forget impactful positions that are feeling the pressure of the value-based transformation movement: social work, case management, and home based care providers. These roles have increased attention due to the instrumental role they play in managing care transitions and ongoing care management. They bear the weight of moving the needle, clinically and financially, and are often excluded from the ability to be financially rewarded based on savings accrued. Within the home care industry, “…an estimated 46 percent of home care workers depend on Medicaid for their health coverage. Medicaid is also the largest payer of home and nursing care services, which means the poor are essentially taking care of the poor.”
Health systems need to allocate resources to retain their workforce and acknowledge the contributions of their various departments.
Finally, health systems are employers too. Develop incentives to influence your largest asset: your workforce.
- Engage with your community to have impactful interventions.
Patient engagement: these two words are overused and often go undefined. The concept is too important not to mention and health systems must build a variety of mediums to recognize and genuinely connect with the diverse population they serve. Whether the goal of engagement is to manage a chronic disease, prevent unhealthy habits, or administer acute episodes, patients must have connection and timely responses from their coordinated care teams. Engagement is only meaningful if there is an opportunity to intervene with a timely solution; you have to have both.
- Practice financial tolerance.
When transitioning from volume to value-based reimbursement, recognize that the transition will not happen overnight and health systems will live in both worlds for a period of time. Dedicate time to engineer a budget to invest in what is historically considered atypical to pay for – areas such as companion care, telehealth, and transportation. Develop operating agreements with complementary providers (post-acute care providers). Value-based transformation requires health systems to create longitudinal relationships with complementary organizations, recognizing that the traditional health system cannot truly achieve value-based transformation alone. These investments will decrease leakage, reduce unwarranted variation, and will actually lead to appropriate utilization of health services.
- Invest in a data sharing infrastructure.
Payers, providers and community-based organizations need to create a shared infrastructure to manage actionable data from a wide variety of sources. This isn’t a narrow tunnel of data that can be exchanged back and forth; it is the integration of timely and accurate data that can create the opportunity for impact. Once some level of data sharing is achieved, performing analysis on the comprehensive data set can identify where to target resources. And eventually, predictive analysis can be adopted. But it doesn’t have to happen in that exact order, predictive analytics can be used at the bedside to predict post-acute utilization, so the entire game of leveraging data must to be performed at the per-patient level and community level.
Of course these six steps are much easier said (or blogged, in this case) than done, but making progress in each of these areas is essential to achieve better care, smarter spending, and healthier people – something we’re all aiming for. To learn more about the latest data-driven efforts in value-based system transformation, consider joining me at Health Datapalooza next April. This will be a key topic area for the meeting where a diverse audience from the public and private sectors will discuss how health and health care can be improved by harnessing the power of data and technology.
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