The bumpy transition to value-based care (VBC) has encompassed a growing array of different risk-based models – from episodic models like Bundled Payment for Care Initiative (BPCI) to population-based models like Medicare Advantage and ACOs. While many VBC programs initially focused chiefly on quality metrics and not costs, many models today entail true financial risk.
Within the range of VBC models are many different ways of taking risk as well as numerous variations in quality and care delivery requirements. That has certainly complicated the lives of health system executives, but ultimately, clinicians and care managers at the forefront of care are bearing much of the brunt of more complex care management.
From a clinical perspective, providers don’t care which of these reimbursement models a patient is in, yet many of them must now juggle the different requirements of five or six different payment models at the same time. That makes it nearly impossible to keep them straight when making decisions at the point of care and makes it important for health systems to give them the right tools and support to provide care within existing and evolving medical models.
Asking already overtaxed and increasingly burned-out providers to incorporate the quality, care and financial requirements of each VBC model into the care plans of each of their patients is the proverbial last straw. Yet failing to do so puts their organizations at considerable financial risk. While there are numerous population health platforms on the market, most cannot significantly alleviate that burden in real time.
Here are the three essential elements for effective management of care and risk in multiple VBC programs that are typically missing in today’s population health platforms.
Requirement 1: Ability to aggregate data from multiple sources and connect to care decisions that adhere to payment model requirements
Many technology platforms today claim to deliver this information to the physician at the point of care, but can’t readily combine key data from multiple EHRs and claims data streams and then surface the essential insights/care management guidance that would be helpful to physicians in making care decisions.
The industry is ripe for a single platform that can pull data from multiple sources and deliver it in a timely manner, at the point of care, with the right kind of decision support attached to it.
But most solutions have focused on the analytics piece of population health/care management and can’t synthesize and translate it to workflows that help clinicians manage care for each patient in accordance with their health plan requirements.
To be useful to physicians at the point of care, the technology must bring those data streams together and surface the appropriate VBC requirements without overwhelming the provider and while facilitating better care management workflows.
Requirement 2: A flexible and scalable platform to readily accommodate each new VBC program
A workable platform will also need the flexibility to scale as each new value-based program is introduced. For example, CMS is rolling out a new Direct Care Model that presents yet another approach to VBC. Health systems will need to create new reporting and workflow capabilities for each new program in hours and days — not weeks or months. A static platform that needs to start from ground zero each time a new model is unveiled won’t enable health systems to respond as quickly as they will need to.
Requirement 3: Ability to coordinate care and costs throughout the care ecosystem in real time
The third missing element of a successful population health platform is that it must facilitate care beyond the hospital walls to enable connectivity and care management from admission to discharge, post-acute care and even into the home. It’s also critical to identify all of the clinical and financial needs of each particular patient in real time throughout the continuum and quickly determine what’s billable. If you can’t gain that kind of visibility with actionable intelligence, managing bundled payment programs and global risk programs is doomed to fail.
In our next blog, we’ll discuss how AI and deep expertise in integrating diverse data sets can enable health systems to serve up this information in a way that facilitates rather than bogs down the critical care management decisions their clinicians must make hundreds of times every day.
About Mansoor Khan
Dr. Khan is a veteran software company CEO with broad experience in identifying market needs, building a team to answer those needs and establishing brand name excellence. He is currently the CEO of Persivia Inc., which he co-founded in 2015. Prior to Persivia Dr. Khan was the CEO of Alere Analytics, formerly DiagnosisOne, which he co-founded in 2004. Persivia currently provides care management, population health, and quality management software and services to over 250 hospitals, over 4500 physicians in outpatient settings, touching 20M patients.