Fostering Clinical Follow-Through: Engaging Providers in Value-Based Model Adoption

The following is a guest article by Dr. Sanjay Seth, Executive Vice President at HealthEC.

Healthcare leaders charged with implementing population health management programs view the value-based care initiative as a tectonic shift in how healthcare will be delivered in the years to come. Their biggest struggle? Convincing providers that their efforts signify more than an unnecessarily complex administrative endeavor.

Many administrators struggle to get physicians to discuss transitioning to value-based reimbursement models, let alone implement them. The reasons for provider resistance are manifold. Some providers have used fee-for-service models their entire career and are loath to change. Others view value-based models as pressure to do more with less, and struggle to see how data analytics and social determinants of health can effectively and efficiently be incorporated into patient care.

Where will I find extra time to address my patients’ psychosocial issues?

How will increased incidence of chronic conditions among my patients affect performance?

Where will we begin to unify disparate patient data sets?

Population health management programs go a long way to ease these concerns. Solutions that aggregate, normalize and analyze patient data allow providers to treat patients holistically and enable risk stratification, helping clinicians deliver targeted care to the right patient at the right frequency. A recent OIG report highlights dramatic spending drops and improved quality metric performance in Accountable Care Organizations (ACOs) employing such tactics.

Unfortunately, even when feasibility questions are quelled, many providers still fail to see the benefit of participating in value-based programs. With national data showing that less than half of ACOs received added compensation for participating in new care models, ongoing provider hesitation is not surprising. According to 2017 CMS performance data, though 60% of ACOs saved money in 2017, only 34% earned shared savings.

Clearly one of the biggest challenges for implementing value-based models is getting providers to the table. The good news is this can be easily addressed by designing incentives to ensure their participation. Here are several ways savvy leaders can gain physician buy-in.

  1. Host frequent provider-led meetings over the first 6 to 12 months of planning to drive initial engagement. Meetings should focus on education and information dissemination, especially around missed revenue opportunities from regular care processes or from poor scores on a quality incentive program. Address missed revenue opportunities related to transition of care, chronic care management, advanced care planning and overdue annual wellness visits.
  2. Over this period, explain to physicians how population health management programs will work and how the healthcare organization will help providers navigate data sharing and interoperability issues and support case management and care coordination.
  3. Demonstrate the analytical capabilities of the applications designed to help, not hurt, physician team members. Emphasize dashboards that highlight gaps in care and high-utilization patients that cannot be easily recognized using siloed, legacy data systems. Examples include:
    • Patients at high risk for emergency visits, readmissions or complications
    • Redundant or unnecessary medical care, such as duplication of tests
    • Geographic areas with high incidence of disease
    • Interruptions in preventive service utilization
  4. Allow physicians to visualize their highest-risk patient profiles and derive treatment options based on individual needs to see the process in action.
  5. Give physicians insight into their own cost and quality performance metrics, as well as those of others. This will motivate providers to improve performance over time.
  6. Quantify the financial implications of expense reductions, quality improvements and patient satisfaction gains in terms of both group and personal financial incentives.

Again, getting providers to the table is the hard part in value-based model adoption. Once physicians see population health management solutions in action, they will more easily accept value-based care models. Healthcare organizations that offer providers a clear vision of what value-based patient care looks like and a clearly defined plan for achieving the organization’s population health management are best equipped for success.

The shift to value-based care should be a period of self-realization for clinicians. Physicians have opportunities to develop fresh perspectives on treatment by evaluating medical information presented in new and dynamic ways. Leaders should emphasize that value-based care is the way of the future. And the only way healthcare organizations can survive is by driving value through new systems that add data to the traditional reliance on memory and anecdotal information for patient care.

About Dr. Sanjay Seth

Dr. Sanjay Seth is executive vice president at HealthEC. HealthEC is a leading innovator and KLAS-recognized Population Health Management Company dedicated to improving patient outcomes, managing costs and optimizing patient quality of life for customers. A comprehensive solution suite integrates all electronic patient data (any system, any setting of care and in any format) and applies sophisticated analytics to identify provider-specific patterns and guide patient care interventions. HealthEC’s platform helps customers coordinate care and maximize incentive payments by identifying and managing high-risk and chronically ill patients and addressing gaps in care. Sophisticated care models simplify clinical workflow, engage patients in their care and optimize performance to support quality measure reporting.