Bringing Value Based Care Into Focus

By Matt Fisher, Esq
Twitter: @matt_r_fisher
Host of Healthcare de Jure – #HCdeJure

The annual exodus of a large chunk of the healthcare industry to the HIMSS Annual Conference and Exhibition will begin today. While many familiar topics will receive a lot of attention, in my third year as a Social Media Ambassador I intend to focus on value based care or alternative payment initiatives. The adoption of value based care is arguably beginning to turn a corner as adoption increases and tools become more sophisticated.

A primary question I have is whether value based care truly is turning the corner and will begin to hit the critical mass so often cited as necessary to really drive systemic change. Time will tell in that regard, but there are incremental changes that are noticeable. Accountable care organizations (“ACO”), which ostensibly push providers into risk-sharing arrangements, continue to proliferate. It seems as though the number of participants increases following every application period for organizations to join the various Medicare ACO programs. At the same time, commercial insurance companies are also encouraging formation of ACOs.

Another aspect to value based care is the growing attention to bundled payments for different episodes of care. A bundle is designed to drive coordinated care across a spectrum of providers because the identified episode will receive one payment for the full scope of care. As such, it is essential for acute, post-acute and many other providers to develop effective means of working together to survive within the restricted payment universe. Again, Medicare has been leading the charge on bundled payments, but more commercial insurers are taking up the concept as well.

Another component of value based care is direct contracting by employers. Instead of relying upon deals negotiated by an insurance plan, providers will reach out directly to providers and negotiate a pre-determined fee for a service. When an employee needs that service, the employee taps into the directly negotiated arrangement as opposed to going through the insurance coverage.

Each of the above is a different example of what the healthcare industry is experiencing. Given the change, it was only a matter of time before value based care received serious attention at HIMSS. That time is now. The following are sessions at HIMSS that caught my eye in terms of highlighting value based care issues:

  • Going from Good to Great in a Value Based World: Business of Healthcare Symposium – This is a day long symposium technically on the day before HIMSS really starts. Sessions will walk attendees through all areas of value based care from selecting a model to creating alignment among different providers to navigating regulatory considerations. The symposium will be a good introductory to intermediate level of discussions.
  • Social Determinants of Health in Value-Based Care – Value based care encourages looking beyond the walls of the hospital or provider’s office. That means looking at the whole patient. However, help is needed in making such changes because the system is not used to dealing with the information.
  • Population Health and Data Foster Success in 23 MIPS-ACOS! – As noted above, the number of Medicare ACOs is constantly growing. Success is not guaranteed in the program. Newer ACOs have the benefit of learning from prior organizations. The best ones to learn from are the ACOs that have actually generated shared savings. Harnessing data is especially important, but it is also necessary to know which data to analyze.
  • Breaking Down the Barriers Between Providers and Purchasers of Healthcare – One of the models of value based care mentioned above is direct contracting between providers and employers. Some tips will be presented from actual experience.
  • Interoperability Sets the Foundation for Care Coordination – If value based care is about establishing a continuum of care, then it is necessary for data to flow freely between providers. As such, the ever popular topic of interoperability will play a factor. Some providers have actually achieved effective data sharing. Are these solutions scalable and/or replicable?
  • Managing a Risk Based Population Health Program – Implementing value based care models is not easy. Mistakes can appear without noticing from a lack of experience or lack of examples. Learn from common errors experienced by others.

The above list is only a sampling of the value based care focused sessions that will happen at HIMSS. Check them out and then share what has been learned and drive conversations. True success will require a collective effort.

This article was originally published on Mirick O’Connell’s Health Law Blog and is republished here with permission.