Before you can succeed at value based care vs. volume based care; you need a workable definition of value. In the healthcare context, value is defined by cost cutting processes while delivering measurable and reportable improvements to patient’s health.
“If value improves, patients, payers, providers, and suppliers can all benefit while the economic sustainability of the health care system increases,” says The New England Journal of Medicine.
In a nutshell, healthcare needs to be driven by measurable results. Measuring performance is not a new concept to healthcare. Indeed, IT services has been driven by the need to not only streamline services but keep a database of information that one can query and see patterns and act upon those patterns. The major difference, up to this point, is measurement has been focused on operations and financials. In a value based system, patient outcomes must be put into a format that can also be queried and trends identified and acted upon; hence the importance of a fully functional EMR. A standalone EMR will not comply with requirements of value based analysis. Interoperability is critical to the full picture. Data “blending” (the newest buzz- word) requires skills your current personnel and systems may not possess. Now is the time to assess your capabilities and your systems capabilities to “blend” data from a variety of sources to achieve a full understanding of patient needs and outcomes and the financials associated with that.
If value improves, patients, payers, providers, and suppliers can all benefit while the economic sustainability of the health care system increases.
Outcomes also contain a “cost” component. Outcomes relative to cost must be considered. Risk sharing, or multiple providers sharing accountability for outcomes both cost and patient is a complex challenge that will be tried and honed for years to come.
Make no doubt, there will be winners and losers in this value based world. Home care, tele-health, sophisticated IT systems and team care approaches will become in vogue. The larger healthcare systems in the country have already anticipated this and are busy establishing networks of people, systems, and tele-health equipment to meet these challenges.
Smaller practices cannot and do not have to compete with these mammoth systems, but smaller practices must produce value and prove they have done so. As IT has become the most challenging and changing entity in this value based world, many large facilities are outsourcing IT services to gain that fixed cost advantage and still be able to compete on value produced.
Your practice needs to begin an assessment of its ability to not only produce value, but also be able to measure and report that value. That’s the biggest challenge for small practices.