Implementing Change

Contributed by staff writer Amanda Fraraccio

In March, we explored value-based care and how it differs from fee-for-service healthcare. How does this transition take place?  Most experts agree there are a few basic steps to this complex process. The steps are highlighted here from the website healthmanagement.org

 Measure Results

For many, transforming their practice to value-based care begins when a clinician starts measuring a discrete, but meaningful, set of outcomes.  These outcomes often surprise when they uncover faulty assumptions about patient care.  When providers see their patients have improved outcomes because they questioned procedures and changed their practices, it can bring great pride and satisfaction in their work.  One meaningful measurement leading to positive change often leads to the next measurement (Teisberg & Wallace, 2017).

 Document Care Paths

In fee for service healthcare there can be different treatment paths for any given set of patient circumstances.  It can be surprising for organizations to learn there is a lack of shared norms.  Understanding how care is delivered is an important step in moving toward value-based care. Identifying care paths can expose discrepancies, and redundant practices.  Exposing ineffective and inefficient practices can allow for more accurate analysis of patient care costs and finding ways to reduce them.  Cost of care is a significant roadblock in the value-based model. This step can be the difference in transforming a system. 

Another roadblock is clinicians can feel restricted by standardized care plans.  An important aspect of adopting norms is to ensure it is done within a culture of guidelines and checkpoints not to replace professional judgement (Teisberg & Wallace, 2017). 

 Create Teams 

A cornerstone of value-based care delivery is development of a team to coordinate delivery of care from start to finish to achieve improved patient outcomes. The most successful teams share objectives, trust each other, communicate effectively, and measure results together. An added benefit of the team model is it can lead to decreased burn-out among clinicians (Teisberg & Wallace, 2017).  

In a fee-for-service model, individual providers are incentivized to order more tests and procedures, for as many patients as possible, so that they can get paid more, regardless of patient outcomes. In a value-based care team, members share risk and reward.  They are incentivized to improve patient outcomes while reducing costs (NEJM Catalyst, 2017). 

Human-Centered Design 

Currently, most healthcare services are centered around providers and their training rather than around the needs of patients. Typically, patients are responsible for coordinating the many complex aspects of their own health care.  An example of a patient having to manage their care is “If the fast food sector followed healthcare's structure, lunch might require visits to three separate restaurants to get a burger, fries and a drink (Teisberg & Wallace, 2017).” 

Leaders in value-based healthcare recognize that to make care more effective, it is necessary to look at the care path from the perspective of the patient (Teisberg & Wallace, 2017).  

Moving from a fee-for-service system will take time. It is a complex transition and providers are facing a difficult challenge: being paid less to produce better outcomes (Cosgrove, 2013). There are short term financial losses before longer-term costs decline. However, this model may be the best method for lowering healthcare costs while increasing quality care and helping people lead healthier lives (NEJM Catalyst, 2017).

References

Cosgrove, T. (2013, September 24). value based healthcare is inevitable and thats good. Retrieved from Harvard Business Review: https://hbr.org/2013/09/value-based-health-care-is-inevitable-and-thats-good

NEJM Catalyst. (2017, January 1). What is value based healthcare. Retrieved from NEJM Catalyst: https://catalyst.nejm.org/what-is-value-based-healthcare/

Teisberg, E. O., & Wallace, S. (2017). HealthManagement, Volume 17 - Issue 1 2017. Retrieved from HealthManagement.org: https://healthmanagement.org/c/healthmanagement/issuearticle/four-steps-within-your-stride-surprising-insights-from-implementing-value-based-care-delivery