Key considerations for moving to value-based care

The path to value-based care is unique to every healthcare organization. While no two health plans or health systems are at the same place in that journey, the end goal is the same: provide the best outcomes for member and/or patient populations, while also improving their experiences and reducing costs.

Organizations are trying to gain enterprise alignment, as well as prioritize converging cost and quality imperatives. Likewise, they are seeking help harnessing the growing amounts of data. While there’s plenty of data to work with, it’s discovering how to turn data into action that’s challenging. It takes the right reports and analytics to target meaningful opportunities for clinical and financial improvement.

From IT systems to workflows, each organization must think through its solutions and strategies for managing the care of its distinct populations. It’s vital to demonstrate both high care quality and the value of services provided. At the same time, however, organizations must support members and patients as consumers, meeting demands for convenience and transparency.

Transformation support
Addressing all of these converging needs creates new opportunities. However, realizing the opportunities requires organizations to first zero in on managing increasing marketplace risk – especially for high risk or rising-risk populations.

A variety of support systems can help organizations move toward value-based care and manage both clinical and financial risk with confidence. As they get started, here are key areas organizations should consider:

Population health readiness. Building a strong value-based care program begins with gaining an objective understanding of where an organization is on its journey. A population health program assessment can help uncover care management shortfalls as well as operational readiness and governance gaps that must be addressed to reach desired performance goals.

This assessment should focus on key areas such as organizational foundation analytics, care management models and provider payment models — all of which helps prioritize efforts to deliver measurable performance and outcomes.

Next generation care management. Care management is at the core of solid population health and value-based care strategies. A robust intelligence-driven, dynamic care management program should align people, processes and technology to maximize organizational efficiency and engage patients and/or members where they are to improve health outcomes.

Organizations should enhance care management action plans by evaluating their processes for case and disease management, utilization management, reporting and auditing, medication reconciliation, workflows and overall use of technology. In addition, analyzing network utilization can help organizations increase retention and referral rates, as well as deliver an improved member or patient experience. It’s important to keep flexibility in mind, since organizations need the ability to scale and pivot as the market shifts.

Creating an enterprise data strategy. Uncovering areas for improvement requires the ability to harness the power of disparate sets of data. To get there, organizations must incorporate predictive analytics monitoring as a key part of their value-based care initiatives.

Creating a data strategy is becoming increasingly vital to optimizing data use. Then, with an analytics solution in place, organizations can identify highest risk and rising risk populations to gain insight on which programs to focus on for the greatest impact to care quality and cost.

Improve care management and the bottom line
Ultimately, each organization must find the best way to better manage the care of its populations — especially those at greatest risk – to improve patient satisfaction and the bottom lines.

No two organizations are on the same path to value-based care. Yet the benefits to taking an objective look at the very foundations of value-based care are clear: improved operational efficiency, better financial outcomes and most importantly improved clinical outcomes and patient satisfaction.

Carolann Engler and Jackie Luchsinger are Principals within Aerial Advisory Services at Medecision.

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