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Since the start of the COVID-19 outbreak, patient volume has dropped about 60% for practices across the United States, causing a 55% decrease in revenue, according to Medscape. With our current healthcare system predominantly built around a fee-for-service model, this pandemic has shown us all how the current system can make both providers and patients financially vulnerable. The need to transition to virtual value-based care has never been more pressing.
In value-based care agreements, providers are reimbursed based on patient health outcomes. They are rewarded for helping patients improve their health, reduce the effect of chronic conditions, and live healthier lives. Below, we outline a few strategies on how to advance value-based care as the healthcare delivery model to use during and after a crisis.
After months of uncertainty from a pandemic, practices contended with the idea of reopening and providing patients the care they need safely. In this blog, we outline four challenges practices may face when reopening during a pandemic and what many providers are doing to overcome them.
According to the Centers for Disease Control and Prevention (CDC), 90% of the nation’s $3.8 trillion in annual healthcare expenditures are for treating chronic health conditions. As chronically ill patients’ health outcomes improve, the costs associated with their ongoing care could be reduced. That is the goal of value-based care. Additionally, by improving patients’ health outcomes, value-based care reduces the compounding complexity and disease progression that drive the need for more care.
For example, a patient whose diabetes does not progress to kidney failure or blindness becomes less expensive to care for than a patient whose condition continually worsens over time. Focusing on clinical outcomes that keep patients healthier in the long-term will reduce healthcare costs and improve the quality of care.
This can be found in a case with Blue Cross Blue Shield of Massachusetts. It implemented a value-based care program among its physicians and hospitals for delivering high-quality patient care and for controlling costs. The researchers saw a decrease in average annual medical spending on claims for the Blue Cross Blue Shield members and their savings increased by up to 12%. Not only did their financial outcomes improve, but the patients in this program received better preventative care. They also achieved improved management of their chronic conditions such as high blood pressure and diabetes.
Caring for the outcomes of chronically ill patients is necessary as more than just a population health strategy. It also becomes increasingly needed during times like the COVID-19 pandemic. Patients with chronic illnesses are at a higher risk of experiencing worse symptoms of the virus. By measuring their outcomes and working to improve them, it can benefit their healthcare costs, quality of living, and even improve their risks during a crisis.
With value-based care being the care model of the future, it’s important to design its programs with the right tools. Virtual care proves to be an asset in delivering value-based care to patients.
The COVID-19 outbreak not only modified our care model delivery but also sped up the transition to telehealth or virtual care. The CDC reported that telehealth visits increased by 154% during the last week of March 2020 compared to the same dates in 2019. With patients avoiding the doctor’s office or having trouble accessing care, virtual care models can bridge the gap of delivering care to patients.
Remote patient monitoring (RPM) has been a beneficial tool during the pandemic. Its devices allow providers to monitor their patients’ health and increase patient access to care team support. For example, patients can stay safe at home while their weight scales, blood pressure cuffs, pulse oximeters, and/or blood glucose monitors relay their vitals back to the provider in real-time. The benefits of RPM include:
Virtual care tools such as RPM improve the lives and health of patients by letting providers address their issues sooner rather than later when concerns escalate to the need for more urgent care. It is also more convenient by delivering care directly to patients in between office visits and increasing their access to care. Providers that are utilizing virtual care during the pandemic are seeing the value in using solutions like RPM as a regular and necessary part of their value-based healthcare models moving forward.
A key in succeeding with value-based care is focusing on prevention-oriented population health tactics. Prevention tactics can extend past office visits and at-home care. It can also start by improving the community and social determinants of health that surround patients.
Social determinants of health (SDOH) are defined as conditions in the places where people live, learn, and work that affect an array of health risks and outcomes. When COVID-19 spread, many SDOHs were disrupted, surfaced, or intensified than ever before. For example, access to telehealth, transportation, and employment were all SDOH that existed before coronavirus, but the pandemic intensified barriers to them.
Value-based care can be improved and integrated with SDOHs. While payers typically support more screenings, data, and advanced electronic health records (EHR) for value-based care, they can also support community-based organizations. These organizations are the first ones to assess and address social determinants of health alongside health conditions. During times of crisis, they may face resource and funding shortages when they are needed most.
Stepping up to support these community-based organizations can help bring resources and care to patients. Improving the places they live and the health risks they face can better prevent them from worsening their conditions. When patients live in better conditions, they can manage their illnesses and take the necessary steps to have a healthier lifestyle. Social health needs are as vital as health and cost factors in keeping patients well and driving value-based care to them.
Value-based care was developed to improve the quality of care delivered to patients, but for the level of care to increase, low-value care needs to be reduced. Before the pandemic, low-quality cancer screenings for colorectal, prostate, and cervical cancers were still prevalent. When the coronavirus outbreak happened, screenings decreased significantly as fewer patients were visiting their physicians and hospitals. Now as screenings and regular checkups pick up again, the healthcare industry needs to decide what kind of medical procedures it wants to deliver.
In the American Journal of Managed Care, it recommends practices and hospitals leverage an alternative payment model that bases reimbursement on patient outcomes. In this model, providers are rewarded for improving the health outcomes of patients by delivering high-value clinical services to them. It also reduces or eliminates payment to low-value care.
High-value care can also increase by utilizing EHRs to make it easier to order higher quality care with simplified processes and discourage the use of low-value care with alerts. For example, the American Journal of Managed Care found that multiple EHR systems highlighted the gap between the ease of ordering and the evidence-based value of clinical services. EHRs can also be integrated with virtual care solutions such as RPM to improve the delivery of service and maximize efficiency for positive clinical and financial outcomes.
Low-value care such as poor cancer screenings can be eliminated by reimbursing for high-quality screenings and leveraging EHRs to better healthcare processes and efficiency. Giving focus and payment to what truly matters: better valued-based care to patients.
Building a solid care model that supports providers and patients will not only help them during a crisis like the pandemic but create a healthcare system that is clinically and financially stable long afterward. Healthcare can no longer just rely on the number of services. Reimbursing for the quality of care and outcomes of patients ensures better delivery of healthcare for today and the future.
If you would like to learn how Wellbox can help advance your value-based care, contact us to find out more.
Considering implementing virtual care at your organization? It may be easier to succeed with its valued-based solutions than you might think.