A Shift to Value-Based Healthcare

Shift to Value-Based Healthcare

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Healthcare Delivery From an Economic Lens

On a macroeconomic level, on-going efforts are being implemented in reducing the cost of healthcare in the US. Since the enactment of the Patient Protection and Affordable Care Act (ACA) in 2010, more people now have access to healthcare. The combination of increased utilization and increased prices is driving increased urgency to address rising healthcare costs. In a report by Peter G. Peterson Foundation, healthcare spending is increasing largely due to the older population and chronic healthcare conditions including overweight, diabetes, heart disease, kidney disease, and cancer.. This places increased pressure on the acute and post-acute care industry to reduce costs, primarily by avoiding hospitalizations.

 

On the other hand, this implies that healthcare providers have a larger pool of patients to treat. By focusing attention on early diagnosis and intervention, more complex and costly health conditions can be avoided. With effective patient centered care, expensive trips to the emergency room and hospital admissions can be avoided. It is important to note that not all healthcare is delivered equally.

Delivery of patient centered healthcare services depends on the patient’s risk profile and needs while maintaining a low cost. The transition to value based care is the only way to balance an organization’s budget while delivering better healthcare outcomes.

Fee for Service
Fee for Value (Value-based)
Focuses on the quantity of services provided
Based on quality of services provided
Fragmented specialist care focused on high intensity intervention
Coordinated integrated team approach to collectively deliver patient centered care with focus on prevention and early intervention
Compensation determined on the services used. The more tests/ services, the higher the compensation
Reimbursement determined based on patient’s outcomes
Control within care episode setting only
Visibility and care collaboration across healthcare settings with particular attention to patient centered transitions

The Shift to Value Based Healthcare in 2020

The Patient Protection and Affordable Care Act (ACA) provided new elements to the push in value based care. According to the Fox Group, LLC (2019), Congress created a “new payment methodology for physicians based on merit and quality of care provided”. What this means is, for example, that physicians cannot prescribe a list of tests unless the patient really needs it. Seems simple but healthcare is a complex system.

Paving the way to value-based care, the interaction is not just between one doctor and a patient, it is between a team of doctors, nurses, rehab specialists, etc. Instead of going through a checklist of symptoms and prescribing medicine, providers need to stay in the loop on the patient’s progress/ healthcare plan. This can be done via effective and fast (almost instant) communication amongst the team to assure that hand off communication in nursing teams is effective.

One leading example of a value based care compensation model is PDPM (the Patient Driven Payment Model). The Centers of Medicare and Medicaid Services announced that as of October 1, 2019, ‘the Patient Driven Payment Model (PDPM), will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay”. The goal of PDPM is to improve payment accuracy (to providers), be more patient focused rather than the volume of services, reduce administrative burden, and improve SNF payments. In a nutshell, instead of going through a checklist of symptoms and prescribing medicine, providers will be working be working together to improve healthcare outcomes.

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PDPM consists of 5 components or ‘bundles’
  1. Physical Therapy (PT)
  2. Occupational therapy (OT)
  3. Speech Language Pathology (SLP)
  4. Nursing
  5. NTA

These 5 components must be tailored to each patient. Every patient is different, therefore, will not utilize all 5 components equally. Some may require more services than other. Hence, payment is based on the appropriate usage of these bundles.

This transition has an overall effect on population health as there will be an improvement in healthcare delivery in an efficient and value based environment. The core of the problem or gap is effective communication amongst the healthcare team. Yes, we live in a technology advanced age, however, with fast paced work environments, crucial information can get lost in translation. The goal of value based healthcare delivery is to provide effective healthcare innovatively and efficiently. This can be done seamlessly with technology.

The Role of Technology in Value Based Care

As healthcare moves towards more Value Based Care models, healthcare apps for patients have become increasingly important. EHRs (Electronic Health Record systems) provide the opportunity to track more and more data and make it accessible to providers. The challenge has been communicating across providers in multiple healthcare organizations. In order to provide effective patient centered care, primary care physicians need real-time visibility into their patients’ changing conditions.

Specialists and hospitalists need to communicate with downstream care organizations about recovery needs and appropriate therapies. Nurses in post acute settings need to be able to seek advice about potential complications as they monitor patient status.

Hucu.ai enables the patient centered communication and collaboration necessary for effective value based care. Hucu.ai bridges the communication gap with easy to use tools that makes it easy for the team of providers to stay on top of the patient’s care cycle. Everyone is on the same page on the patient’s health. For example, if a patient’s GP alters a medication and records it in Hucu.ai.

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The patient then goes to an allergist who can immediately see the medication change in Hucu.ai. In a traditional setting, the allergist’s nurse would have to call/ request a fax of the new medication, thus, losing time, efficiency, and a delay in catering to other patients. Hucu.ai (HIPAA Compliant Messaging) makes it simple to communicate. More and more innovative value based providers are joining the Hucu.ai network. To request and invitation to the Hucu.ai communication network, click here.

The shift to value-based healthcare will deliver high quality care and improve population health at a low cost. Medical communication apps like hucu.ai will pave the way. Click here to be notified of news.

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