How health systems can position affiliate provider groups for success in value-based care

The concept of value-based care sounds simple, reward providers for the quality of care delivered instead of the volume of care - so why is the successful implementation proving to be extremely difficult?

In an October Becker's Hospital Review webinar sponsored by the Stellar Health, Zack Caplan, vice president of provider network and strategy at Stellar Health, and Helen Rinaldi, executive director of network management at UNC Health Alliance (Chapel Hill, N.C.), shared how health systems can empower their affiliate provider groups to change behavior at the point of care. This strategy becomes the foundation for value-based care success.

Three key takeaways were:

  1. Align incentives with the day-to-day behavior that actually leads to improved outcomes. "One of the inherent challenges within value-based care is a misalignment between how primary care clinics are compensated vs. the granular, day-to-day tradeoffs that providers and their care teams must make at the point of care to actually improve outcomes,” Mr. Caplan said. “Primary care clinics are often asked to make significant investments of their team’s time and resources, all in the hopes of getting a big bonus check in 18 months." Primary care clinics are often short-staffed and are already stretched for resources. If you want your primary care clinics to spend the extra 5 minutes with a specific high-risk patient or to reach out to a certain patient about a specific follow up item, you need to compensate them appropriately for the opportunity cost of taking that time. Primary care clinics deserve to be able to make these day-to-day decisions with transparent, real-time insight into how much extra they will be compensated for completing these high-value actions.
  2. Align value-based care metrics to the language of your affiliate practices. According to Mr. Caplan, it's critical to get "all of your affiliate practices rowing in the right direction." He offered tactical tips to drive performance among affiliate provider groups:
    • Break down metrics into their workflow steps. For example, colon cancer screenings are often considered binary – complete or incomplete. While completing a colon cancer screening may be the goal – the actual individual workflow steps include (1) reaching out to patients due for one, (2) convincing the patient to get their screening, (3) scheduling an appointment with a preferred Gastroenterologist (4) confirming the patient understands the prep, and (5) eventually submitting results appropriately to the payor. Mapping out, tracking, and rewarding each of these granular steps "allows you to pinpoint process breakdowns," he said. "You want to build the data in a granular way. For example, you may have a provider who does a great job convincing patients to go get their screening, but the process actually breaks down every time the patient is scheduled with Gastroenterologist ABC”.
    • Reward each action and the team members who do them. Ms. Rinaldi explained that UNC’s affiliate practices love the Stellar Value Unit (SVU) – the term Stellar Health uses for the actual dollars they incentivize and reward users with, each SVU equal to one dollar. “They’re able to see how individual actions equate to that SVU,” she said. “The staff who do the work are excited to see the value associated with the work they’re doing. They can see individual financial rewards in monthly checks.”
    • Arm each team member with the right data. “It’s all about putting the right pieces of information into your team members’ hands at the right time,” Mr. Caplan said. “Light-touch tools can drive results in bulk, even if your affiliate providers are all on different EMRs and have different staffing structures " he said. A flexible solution needs to fit into each different affiliate practice workflows and should be able to be used across multiple lines of business. 
  1. UNC's pilot program is beginning to generate results. Ms. Rinaldi credits UNC's partnership with Stellar Health for helping incorporate ever-evolving value-based care arrangements into its affiliate programs. "We are not only able to shift priorities in real time using patient data, but teams can prioritize those actions that need to be done based upon performance," she said.  “Getting to a single platform of workflow is critical to our success in value-based care,” Ms. Rinaldi said. “We’ve already increased annual comprehensive visit activity by nearly 10 percent and are seeing wins across the board. It's streamlining the work to enhance patient outcomes."

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