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The past decade has seen an evolution in value-based care (VBC) from a focus on passive management and learning opportunities in 2011, transitioning to active management and an imperative for a return on investment (ROI) that is seen in the industry today. No doubt, VBC is permanent and growing as it becomes an organizational core competency, rather than one of the myriads of organizational initiatives.

Challenge

Our industry research demonstrates that the COVID-19 pandemic negatively impacted 53% of value-based arrangements; however, their strategic importance has never been more evident—nor have the shortcomings in executing those arrangements. In fact, 89% of surveyed executives believe their organization needs to engage in more value-based arrangements, yet only 48% of those executives believe their organization has the capabilities to execute those VBC strategies. Despite the aspirations of many organizations to implement accountable care, multiple factors contribute to unmatched capabilities with strategic VBC needs. These include competing organizational priorities, unaligned payment mechanisms, and delayed ROI. Leaders are juggling all of these while facing some of the worst margin pressures in recent history due to higher contract labor and supply costs, inflation, and negative rates of ROI portfolios.

Path Forward

Successful pursuit of VBC requires value centricity—utilizing clinical, financial, and patient experience data to put the pursuit of the delivery of genuine value-based care at the center of strategic, operational, and financial planning.

Our experience with organizations that put patient care at the center of the value curve, focusing on compassion and physician-patient interactions, has demonstrated that successfully pursuing VBC is not only still possible, but imperative for long-term success. Organizations build capabilities for long-term population health success by:

  • Accelerating innovation across the care continuum, including investing in tools to manage the total cost of care for your community.
  • Generating physician buy-in when implementing value-based arrangements via clinical empowerment and accountability. Providing clinical and administrative teams with the tools and data they need to better care for patients, regardless of setting. 

By honing focus within these areas, leaders will help improve care in their communities as well as reap the benefits across all VBC contracts, agnostic of the payor.

Outcomes

A focus on these areas has driven meaningful clinical and financial results across organizations. One large organization confirmed that the key first step for their organization was creating infrastructure to manage patient populations and utilization. In 2021, they created a population health services organization (PHSO) bringing together administrators and physicians to support VBC by providing care management, risk adjustment, data analytics, and other functions needed to execute their VBC strategy successfully.

Another organization, early in establishing its accountable care organization (ACO), empowered primary care physicians (PCPs) to lead the charge by placing them at the center of the VBC conversation. They also leaned on innovative technology to better understand patient acuity and population health using FORVIS’ data analytics toolkit.

Both organizations emphasized the importance of including physicians in risk-based contracting conversations and empowering them to drive contracting terms so that cost-reducing objectives do not impede their ability to deliver higher-quality care. Finally, both organizations agreed that aligning incentives and making incremental changes are necessary to be successful in VBC.

Conclusion

The transition to value-based models is happening now and moving swiftly, across Medicare, Medicaid, and commercial contracts. Looking forward to the future of VBC, healthcare organizations need to establish value-based arrangements with a value-centric strategy focused on compassion, innovation, and clinical empowerment and accountability. By preparing now, organizations will be better positioned to reap long-term rewards for many years to come. Staying ahead of the curve is essential for success amid the transition away from fee-for-service.

For more information about how your organization can move toward value-based care goals, reach out to a healthcare consulting professional at FORVIS or submit the Contact Us form below.

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