Shifting Culture in Support of Value-Based Care

By now, most physicians are aware of the transition to value-based care (VBC) and the financial ramifications that come with adopting various new reimbursement models. Under MACRA, clinicians must participate in MIPS and/or an advanced APM – resulting in reimbursement that can potentially cause an income variation of $131,600 per provider for the average oncology practice in 2019.

What many do not understand yet is a vital component of the journey from fee-for-service to VBC is cultural change. Physicians, and the practices in which they work, will need to make fundamental shifts in their work culture to change the way they approach patient care. Practices must make more careful choices regarding the holistic value of drugs and incorporate evidence-based treatment paths as clinically appropriate that achieve favorable outcomes while keeping costs in line.

Providers also need to think strategically about clinical and operational matters, like optimal treatment plans and which quality measures to report on (a tricky choice since physicians are graded on a curve). To foster this cultural change and reach the ultimate goal of optimized reimbursement, here are some best practices for physicians:

• Develop new capabilities to embrace population health management through care coordination, case management, evidence-based care pathways, and expansive palliative/hospice care.
  
  
• Ensure medical and financial leadership at the practice is adaptive to evolving technology and open to facilitating change through top-down communications.
  
  
• Monitor clinical and financial KPIs through implementing real-time analytics capabilities to prioritize quality components and shift prioritizes where necessary.
  
  
• Put sophisticated EHRs in place that can document all measures in structured fields to make sure the relevant data is captured and is simpler to integrate, monitor and report to CMS.
  
  

Patient experience is another vital component of practice transformation that requires cultural change, and can be complicated by VBC.  Providers must be aware that as they seek to make smart choices about optimal care plans, patients may have their own ideas and expectations.

Because patient experience has a dual financial impact, affecting both the practice’s reimbursements as well as its market share, successful practices will need to put a strong emphasis on education and communication to ensure a positive patient experience.

As VBC initiatives continue to expand, practices will have a lot of work to do to navigate the important cultural and operational changes required for success under this new paradigm. The good news is that there is a new generation of new population health, clinical, and operational tools available today to facilitate, automate and streamline the process of succeeding in the new reimbursement landscape.

Be sure to explore our population health technologies and services to ensure smooth sailing under VBC.