Value Based Health Care — The Reality of Practicing It
Written by: Caitlin Masters, MPH and Amber Emch
Caitlin Masters is the Co-Founder of Weft Health and the Value Based Care Director at DIRA Partners. Amber Emch is the Data Coordinator in the Value-Based Care Department at University of Toledo Physicians.
Value Based Health Care can sound sexy — putting the patient first, paying for outcomes — but in reality, the day-to-day change management and implementation is challenging and grueling. The author’s goal is to provide you with a tangible example of how it plays out in the real world from the perspective of a provider. The article jumps right into how insurance companies overlay payment for quality on top of current contracting demands and what providers need to consider when operationalizing the measures to obtain more dollars.
“Fitting” Value Based Health Care into the Current System of Care
Value Based Health Care (VBHC) is providing stakeholders across the world a set of solutions that can change and improve health care. To achieve the VBHC equation — outcomes that matter to patients divided by the cost — we must track and improve quality of care. One way this is practiced is through the use of standardized performance and outcome measures. Widely used today are Health Effectiveness Data and Information Set (HEDIS) measures and International Consortium for Health Outcomes Measurement (ICHOM) measure sets. A specific selected set of these measures are folded into contracts providers have with health insurance companies, and create an additional dollar benefit to providers for “closing the gaps” i.e. meeting the measure’s agreed upon threshold. The addition of measures into insurance contracts is a step forward to achieving VBHC, but the measures are often difficult to operationalize without intentional thought and change to current processes and workflows. Providers must take a myriad of steps to implement processes to meet the measures to receive the additional dollars; unfortunately, the measures aren’t met with the wave of a magic wand! Therefore, the authors’ purpose in writing this article is to share one of the biggest challenges to meeting the measures and to provide tips on how to make it work in an outpatient setting.
Improvement in the quality of care occurs when we focus on incremental change in the day-to-day practices of health care; people i.e. staff are critical to this.
The Reality of Meeting Quality Measures
The need for new roles is one of the single biggest challenges within the operationalizing of value-based care. Meeting the quality measures that are a part of current insurance and pay for performance contracts require staff inside and outside the clinical setting. Often time, the staff, both clinical and non-clinical, are expected to absorb the new tasks within their role because current staffing structures and models have been slow to adapt to the change in practice. Therefore, health care systems often create a piecemeal process to address the quality metrics and close gaps in care. For example, in one system, a staff member outside the clinical setting scrubs the data provided by insurers and sends it to the appropriate outpatient practice on a monthly basis coupled with scorecards showing current performance. It is up to those in the clinical practice to review the report, identify where the quality gaps lay and create a plan to contact the necessary patients to close the gaps. This heavy burden weighs on clinical staff who feel the pressure to close the care gaps but do not have the capacity to do so.
Not all is lost though, as there are tried and tested models that have adapted to the changing staffing needs required to meet value based care measures.
Solutions for Operationalizing Quality Measures
People are your biggest asset. Team-Based Care is one of the most critical aspects to meeting quality measures because it aligns your people and motivates them to work toward a single outcome. Critical to team-based care is that the team include both clinical and non-clinical staff.
One company that has done this well is Oak Street Health, who has a data “ninja” on each team who prioritizes the quality metrics that need to be met, runs reports, and drives homes that health care is practiced individually even if we often create interventions at the population level (Oak Street Health). By leveraging IT as much as possible within the daily, weekly, monthly and quarterly reports, it drives decision making. In the authors’ experience, it is not yet realistic in a typical outpatient setting to hire dedicated data experts for each team, but there are still ways around this. By having a dedicated VBHC data team coupled with on the ground VBHC coordinators, it is possible to continually integrate data into your decision making, therefore focusing on the patient’s needs as well as closing the agreed upon quality metrics. An additional piece of the puzzle is that “culture eats strategy for lunch” as Peter Drucker famously said, therefore think about cultural fit when re-thinking organizational structures to meet value-based health care measures.
Hire for culture. If you don’t hire and retain service-oriented staff members who can help deliver value-based care, be prepared to take a hit to your bottom line.
Although there are many challenges to operationalizing a system or practice to meet quality measures, the author’s recommend to start by focusing on the people.
If you’re interested in additional tips and tricks on this, please contact the authors, Amber and Caitlin, who are tagged below.
Caitlin Masters — LinkedIn
Amber Emch — LinkedIn
References:
Health Effectiveness Data and Information Set (HEDIS) measures- https://www.ncqa.org/hedis/
International Consortium for Health Outcomes Measurement (ICHOM)- https://www.ichom.org/
Oak Street Health - https://www.oakstreethealth.com/
