The healthcare industry’s wholesale shift toward value-based care (VBC) has been— and will continue to be — complex. That’s especially true for specialties, which represent the first reform wave.
Why? Because costs and risks both tend to be higher for specialty practices than they are for primary care.
To protect their specialties’ revenues, hospitals and health systems’ VBC transition planning must therefore be similarly complex. They should develop core capabilities that meet their specialty practices’ unique needs while broadly reducing data silo-ization and improving communication between providers.
It’s a tall order, but it can be done. And there are several key areas that health systems should focus on from the start. The five listed below are great places to start.
1.) Make enterprise-level care coordination a strategic priority.
Under VBC models, strong care coordination systems will reduce — through better use of conservative care paths and treatment plans for individual patients — the financial risks associated with bundled payments and direct-to-employer contracts. Specifically, they can also provide more detailed insight into risk levels for individual patients, and provide it sooner and with recommendations for direct action.
In the last century, outcomes in medicine were measured in terms of individual providers’ or care centers’ achievements.
Now, value-based care has made healthcare more like a team sport, with patients and multiple providers all working toward common goals. Care coordination reflects this reality and links individual team members. In the world of risk-based contracts, such teamwork is more than a nice-to-have.
2.) Develop and implement electronic medical record (EMR) platforms that broadly support inter-provider communication, but preserve specialty-specific features and protocols.
The biggest players in the EMR market tout their care coordination capabilities, but many of their systems reinforce data silo-ization to a certain degree.
Most are organized by and optimized for the specialties (or, in some cases, even for specific chronic diseases), but don’t give providers the ability to “zoom out” and view a patient’s entire care scenario.
This makes life especially difficult for care coordinators: they can’t do their jobs effectively or efficiently when they have to spend time navigating among an EMR’s specialty zones, patchworking together (or worse, inferring) a comprehensive view of the patient’s health and course of care.
Health systems can improve the situation by working with EMR providers to develop capabilities that serve specialty-specific workflows but support the need for multi-scale observation and analysis.
3.) Continually analyze data to learn which social determinants of health (SDOH) are most commonly affecting their patient populations’ outcomes.
Complex patients (who most need coordinated care) typically exhibit co-morbidities. Many face external factors (e.g., financial concerns, social stressors, behavioral health issues) that make recovery more difficult.
It’s important that health systems understand, down to the specialty level, which SDOH are holding their patients back, so that they can work to address them and give their providers a fighting chance at improving care outcomes.
4.) Develop, test and perfect patient engagement efforts.
The default view is that patient engagement is a practice separate from care coordination involving general principles (like guidance from doctors and encouragement to patients).
However, in complex specialties, patient engagement activities and content are specific to certain conditions and treatment types — and essential to promoting better outcomes.
Hospitals can learn from effective practices that were defined in other industries. True engagement requires proactive and personalized outreach, as demonstrated by leaders in online marketing, eCommerce and other fields.
Basic reminders, follow-ups and other straightforward tasks could be automated, which would in turn free care coordinators and navigators to focus on those highest-risk cases where they can make the most difference.
And, to ensure automated messages are as effective as possible, they should be personalized and delivered in the channel (e.g., text message or phone call), tone and frequency patients prefer.
True, this would require health systems invest in psychographic data analysis capabilities — an added cost, but one that would almost assuredly yield significant returns on investment.
Automated workflows and exception management tools could be leveraged to help nurses and care coordinators focus on clinical care tasks and allow administrative coordinators and social workers to focus on the patient interactions that are most appropriate for their skill sets.
And, ideally, care coordination processes and technologies would provide intuitive access to information about appointment, events, co-morbidities and other risk factors to all the members of the care team — clinical and non-clinical alike.
They should provide detailed assessments of individual patients’ risk levels and recommendations (appropriate to the caregiver’s role) for direct action.
With such, the care team (physicians, nurses, coordinators and navigators alike) would all have the same, broad-level view and, accordingly, an improved ability to keep patients on track with SDOH-tailored treatment plans.
5.) Work with providers, care coordinators and community resources to develop interdisciplinary, extra-clinical interdiction models.
Care coordination and patient engagement should be viewed in terms of training patients to be effective participants in their own care teams, by directing and motivating them to take actions that lead to better outcomes.
If we develop capabilities that automatically recognize and alert staff to symptom changes, or to divergences from prescribed regimens (i.e., failures to fill prescriptions, appointment no-call / no-shows, etc.), we can develop extra-clinical interdiction measures that would help get patients back on track.
Such cost-effective, proactive measures would significantly reduce emergency department utilization and post-treatment readmissions, help providers to maintain patient outcome success and, of course, improve population health.
Preparing for the Future, While Realizing Benefits Today
Are these ambitious goals? Yes. But there’s no question that the effort and investment necessary to make them a reality can pay off – and not just in the future, as value-based reimbursement becomes more prevalent. VBC is pushing all providers — primary care doctors and specialists alike — to manage the whole patient. It begs for enterprise-level, platform approaches and proactive protocols that recognize the unique needs and best practices of individual specialties.
In terms of technology, we don’t need five different tools or applications for five different specialties. Rather, we need a single platform that can be extended to support multiple specialties, with tailored information streams and protocols embedded in the interfaces for each type of user.
Improving clinical quality, lowering costs and delivering better patient experiences under VBC requires a different mindset and bold approach — especially as the industry adjusts to risk-based payments.