Value-based care is a shift from focusing on volume to health outcomes. It puts patients first and reduces costs while improving patient health.
Value-based programs motivate healthcare providers with nonfinancial incentives like increased quality of care, a sense of purpose and mission, professionalism, and patient satisfaction. They also help manage CMS risk through accurate HCC coding and risk adjustment.
Integrated Digital Systems
In value-based care, practitioners are paid based on the quality of services they provide rather than the quantity. This makes for healthier patients, happier practitioners, and less spending throughout the medical industry. But to fully realize the potential of value-based care, you need integrated digital systems that connect and share data across your healthcare ecosystem.
For example, telehealth software can improve patient wait times for low-acuity conditions like urgent care. Pediatric Associates, a pediatric practice, saw a 75 percent decrease in wait times with their telehealth triage program. Similarly, Health Care uses a system to reduce operational efficiencies and improve staffing supply by using real-time patient data to predict future demand for specialty services.
In addition, remote patient monitoring via connected devices and wearables provides continual, real-time patient condition data. This enables healthcare providers to adjust treatment plans from anywhere, improving outcomes and reducing hospital and emergency room visits. And using a centralized, streamlined system can improve employee productivity by eliminating manual operations and allowing employees to focus on more critical projects like patient engagement.
Healthcare providers can make a difference in patient outcomes and reduce costs when they have real-time data. With cellular remote monitoring devices, like blood pressure monitors, glucose meters, oximeters, and weight scales, sending continuous data streams to provider systems, there are limitless opportunities to improve patient care.
For example, real-time analytics can help prevent medical errors and improve drug therapy by identifying possible side effects, drug interactions, and toxicities. It also supports patient safety by alerting clinicians to clinical deterioration, like sepsis, so they can take prompt action to save lives.
The current fee-for-service model incentivizes the wrong behaviors, focusing too much on how many tests or services are performed rather than patient health outcomes. Value-based care provides a new framework to drive better patient outcomes and lower costs. The key is integrated digital technology that connects healthcare networks across care settings. This includes payers, hospitals, physician groups, and post-acute/community networks. This is essential for realizing the potential of value based care software.
Data-Driven Decision Making
Some states spend the most on healthcare but rank at the bottom of eleven high-income countries for access, equity, and outcomes. The system needs improvement, and value-based care is a crucial step.
However, the success of any value-based care program will depend on how well it is managed and what steps are taken to ensure that the data used for decision-making is accurate. The best way is to employ a data-driven business model that uses predictive analytics to support unbiased and evidence-based strategies and decisions.
This includes collecting, analyzing, and interpreting data for clinical integration and patient engagement. It also means ensuring that any data being used is sourced from reliable, trusted sources and that the data is free of errors or redundancies. This will reduce the risk of misinterpretation and inaccurate results. It will also help practitioners avoid making decisions based on gut feelings or assumptions and optimize patient engagement. In turn, this will lead to healthier patients and lower costs.
Population Health Management
The study of population health is a complex field that combines healthcare, data analytics, and community outreach. This combination allows organizations to achieve what the Institute for Healthcare Improvement of improving patient outcomes, enhancing patient experience, and lowering healthcare costs.
In a value-based care system, this translates to focusing on prevention. A shift to a focus on preventive care should lead to healthier communities and savings for the overall healthcare system.
This involves identifying and monitoring specific groups of people with similar healthcare needs, such as those in the same age range, gender, or profession. This helps to reduce hospital admissions, readmissions, and lengths of stay.
Organizations need the proper infrastructure to support the growth of value-based care effectively. One way to do this is by leveraging specialized software designed for medical records management, analytics, and predictive modeling. This software can help to improve clinical treatment and lower costs by identifying disease suspects before they present themselves. To pursue a career in this field, an online Doctor of Nursing Practice degree can prepare experienced nurses and nurse practitioners to take on leadership roles in population health management.
In value-based care, providers are reimbursed based on the quality of healthcare services they deliver to patients. This encourages practices to focus on providing high-quality, effective, patient-centered healthcare that results in positive outcomes.
By focusing on improving health outcomes, value-based care reduces costs for all stakeholders involved in the system. Better results decrease the likelihood of disease progression that drives the need for ongoing maintenance, lowering payer premiums and the cost of managing co-morbidities.
Value-based care programs also promote nonfinancial incentives for clinicians to improve quality and engage with their patients. This means that providers participating in value-based care programs can benefit from a sense of purpose, mission, professionalism, and financial benefits. In addition, patients and payers can benefit from a system that prioritizes preventive healthcare and long-term provider relationships that can help reduce chronic condition risks. The result is diminished costly emergency room visits, hospitalizations, and readmissions. The cost savings can then be used to provide more comprehensive healthcare for all needy patients.