Every year the predictions include moving closer to value-based care. But are we really moving as quickly as needed to change outcomes and lower costs? Are care models aligning with transformation? Are we really getting true buy-in from providers to see true value-based care? What are the leaders saying they see for 2024?
And join us for the next few weeks as we look at what we might see in 2024.
Evolving the Care Team Further Through Wider Value-Based Care Adoption
In 2024, value-based care can help address clinician shortages by incenting collaborative care teams to focus on helping patients avoid significant, resource intensive care events. In the next year, we will continue to see innovative technology that simplifies patient intelligence sharing and advances interoperability, supporting patient care teams by ensuring they have the information they need to provide quality and less costly care for their patients.
Early signs point to another year of transformation in value-based care. Many providers and practices have decided to join Accountable Care Organizations (ACOs) to better serve highly complex populations and create a more sustainable health system. In particular, expect to see significant growth in the ACO Realizing Equity, Access, and Community Health (REACH) model given the early success of the program. This model allows higher levels of risk and potential reward, as well as more flexibility and options for capitation to those willing to innovate. Vytalize Health’s 2022 REACH results showed that participating provider partners successfully lowered healthcare costs by 7.7% (an average of $1.343 in savings per beneficiary). There is also interest in bringing ACOs to underserved communities so patients and families can take advantage of the increased care coordination and better outcomes that come with the model. ACO REACH and its health equity focus is built for these communities. I anticipate there will be a greater emphasis on enabling Community Health Centers and other safety-net providers to join ACOs with no downside risk and place them on the path to ACO REACH, (or something similar) where they can leverage their understanding of SDOH to further health equity.
Value-based care will continue to expand to include more specialists, particularly cardiologists, given heart disease remains a significant health burden for millions of people. The key to success for value-based care is prevention, and remote monitoring for cardiovascular health can go a long way in improving outcomes for patients while reducing costs by avoiding unnecessary hospitalizations. The approach also promotes health equity by expanding access to expert care, which addresses value-based care’s new quintuple aim. In the coming year, we can also expect to see new payment models emerge that transition remote cardiac care to an alert-based monitoring system that allows providers to see patients in the clinic when there are actionable events. These events will be based on specific data signaling a specific episode or change in condition rather than at time-based intervals. I also anticipate that a growing number of third-party providers will enter into risk-based arrangements and work alongside providers. This will improve the timeliness of remote transmission review and ensure the highest standards for remote monitoring.
In 2024 we can expect care teams to get bigger, broader, and more collaborative as new digital tools and care strategies combine to shift the status quo. Convenience, cost, and consumerism remain top-of-mind going into the New Year, and more healthcare stakeholders are considering offering at-home tests to close gaps in care and advance better health. For example, pharma companies are now starting to engage in at-home diagnostic testing initiatives, including telehealth consults to review results – a task traditionally assigned to primary care and specialists. The trend is driven by a growing focus on health equity and proactive, personalized care. Sending tests to patients’ homes helps overcome SDOH barriers that may prevent patients from getting to a lab for testing. This will lead to more comprehensive screenings, which in turn will result in earlier diagnosis and treatment of chronic disease. For pharma companies, that means a significant number of patients who could benefit from currently available therapies may soon be getting the treatments they need to stay healthy.
Championing the community will be the playbook for VBC moving into 2024. In the new year, independent practices will need to get creative in the transition to VBC, but it’s the industry’s responsibility to support in their effort to do so. In 2024, we’re going to see smaller providers being innovative with their approach. Instead of acquisitions and consolidations, new types of collaborative networks will sprout up; hybrid MSO-ACOs. In the same vein, ecosystem-oriented design and national platform-to-platform data exchange shrink wrapped for independent practices will be essential, especially when it comes to network wide data access for population health initiatives, identifying high-risk patients, supporting interventions, and closing gaps in care. The question is no longer ‘how long until VBC is here,’ it’s here now, but the industry needs to think critically on ‘how does fee for service end,’ which relies on the smallest providers transitioning.
To narrow patients’ care gaps and improve performance in value-based agreements, health systems will increasingly look to virtual care partners to deliver high-quality, cost-effective care to a variety of patients. This may range from 24×7 virtual urgent care visits to decrease inappropriate ER utilization to managing chronic patients virtually via monitoring and consistent algorithms to improve their outcomes, while freeing in-office clinicians to oversee more complex cases, driving greater patient and clinician satisfaction.
With rising pressure on payers and providers to improve care quality and reduce costs, the importance of utilizing data both prospectively and retrospectively is increasing. In 2024. AI is expected to play a central role in value-based care organizations due to its ability to efficiently harness vast amounts of data. AI excels in aggregating and synthesizing clinical data, discerning patterns, highlighting relevant information, automating tasks, and streamlining processes. When the right data is in the hands of the right resource at the right time, proactive member risk profiling and patient engagement become achievable.
With its ability to inform more precise care, genetic testing has a huge role in transitioning to value-based care. Providers and health plans will collaborate more in 2024 on better ways to manage genetic testing to allow it to achieve its potential while still controlling costs and providing greater insight into which testing is most beneficial.
As we move into 2024, patient experience is certainly on the front burner for providers as it impacts not only patient retention and acquisition, but also labor workflows and the shift to reimbursement under value-based payment models via population health initiatives. Patient engagement is the bridge that will empower providers to make healthcare more convenient, accessible, and user-friendly. Healthcare providers need to understand what patients and providers want, and they’re going to have to deploy digital solutions that meet those needs. By focusing on innovative approaches to extend the clinical setting, engage patients wherever they are, and explore staffing models that empower clinicians to work top of license, leaders can move the needle on advancing the best possible care for all.
The coming year should see increased participation in various value-based care (VBC) models created by the Centers for Medicare and Medicaid Services (CMS), each of which has different goals. The ACO REACH (Realizing Equity, Access, and Community Health) model, for example, encourages provider organizations to form Accountable Care Organizations that deliver high-quality, coordinated care. Meanwhile, the Making Care Primary (MCP) model creates incentives for patient engagement, and the AHEAD (All-Payer Health Equity Approaches and Development) model focuses on primary care alignment. Finally, VBC will get a boost in 2024 from the continued use of remote monitoring and wearables as providers strive to bring care to patients where they are, whether that’s in the community or the home.
Jessica Peterson, MD, MPH, Senior Director, Value-based Care Policy, Anatomy IT
Clinicians in Medicare will have to prepare for new EHR requirements in 2024. A new policy in the Merit-based Incentive Payment System (MIPS) doubles the length of the Promoting Interoperability reporting period – from 90 days to 180 consecutive days – to match what is required for hospitals. This may motivate practices to more carefully schedule EHR updates and transitions to ensure 180 uninterrupted days of PI performance. On the patient side, we hope that the application programming interface (API) requirements for all certified EHRs will make it easier for patients to receive their health information from physician practices in the way easiest for them (either through a patient portal or a separate application). These requirements, if implemented properly, have the potential to improve the patient care experience for both doctors and patients.
The transactional ‘upcoding’ approach to diagnosis coding is misaligned with the original spirit of value-based care: enhanced outcomes through superior chronic disease management. By 2025, I expect most progressive health systems will implement integrated decision support tools that surface patient insights at the point of care, enabling providers to deliver and accurately capture higher-quality care.
As more providers embrace value-based care and engage in risk-based contracts, there will be increasing pressure on them to control costs, improve resource allocation, and produce better patient outcomes. Accomplishing those goals in 2024 and beyond will require the kinds of increased efficiencies that can come only from investing in technologies that enable care orchestration, expedite the patient journey, and provide seamless transitions.
Value-based care will continue to be a focus in 2024 and beyond as stakeholders in health care continue to wrestle with escalating costs. Getting clinical care done right the first time is more efficient and effective, and preventing costly complications works even better. Efficient tools and cutting-edge technologies that enable effective decisions in real-time will continue to help providers reach their clinical quality goals and manage patients’ health. With the cost of health care in America rising with inflation, getting high value for every health care dollar will continue to be a critical challenge.
Without access to all relevant patient information, providers and payers will struggle to successfully manage value-based care (VBC). Fortunately, recent advances in artificial intelligence (AI) and machine learning have enabled medical-grade natural language processing (NLP) software that can deliver where traditional NLP falls short – extracting unstructured data, which comprises 80% of all EHR data. Making that EHR data actionable at scale supports VBC with a holistic view of the patient and clinical performance that informs evidence-based decisions. To gain the benefits of NLP, healthcare organizations must meticulously evaluate the accuracy and effectiveness of potential solutions. In 2024, we expect to see more companies begin production-scale implementations as vendor offerings mature and healthcare organizations identify medical AI use cases.
We’re encouraged by health plans and risk-bearing providers that are leveraging supplemental benefits as an integral part of their value-based care strategies and programs, and we hope more industry leaders will do the same. For example, we’re seeing innovative organizations take advantage of preventative interventions, including home safety evaluations and home modifications, healthy meal programs post-hospitalization, ADL support through homemaker and home health aide services, and transportation for both medical and non-medical appointments. With strategic investment and utilization tracking, there is growing evidence of immediate and significant financial benefit for the plans, improved quality of care for members and providers, and an improvement in overall satisfaction with the healthcare system.