Succeeding with Value-based Care Models

Value-based care models are highly attractive to healthcare providers and executives because they hold the promise of increasing quality and reducing the cost of care. Navigating the transformation to value-based care requires a robust set of data from across the healthcare network. For many networks, the cost and time required collecting and normalizing data from multiple EHRs and other systems, if even available, can become so prohibitive that projects never get off the ground.

Given these issues, healthcare executives should prioritize value-based care data projects by deciding which quality metrics can drive early success. Two common early priorities are:

  • Regulatory reporting of state and commercial metrics as well as specific programs such as the Medicare Shared Savings Program (MSSP)
  • Reimbursement-based measures to model, implement, and manage physician incentive programs

Value-based Care: Data Drives Positive Patient and Financial Outcomes

value-based care data drives positive patient and financial outcomes
In order to become a useful tool, data must be transformed into information that can help drive strategic clinical and financial decisions.

To minimize manual data collection and conserve resources, organizations should focus on metrics with readily available data.

Delivering early, achievable projects with manageable implementation expectations and leveraging the success of those projects creates a foundation for quality reporting program expansion. Subsequent value-based care projects could include:

  • A population health management approach to predicting cost of care for specific patient populations
  • Profiling physician engagement and performance
  • Managing data from multiple payers
  • Optimizing margins
  • Effectively managing transitions in care to identify and close gaps
  • Implementing effective and evidence-based care plans
  • Optimizing pharmaceutical spend by switching patients to generics or other lower-cost alternatives

Next: Administering an Accountable Care Organization