Skip to main content

Unlock the Potential of Value-based Payment

Female doctor smiling wearing a hijab.

A common misconception in healthcare practices: Organizations can quickly reap the benefits of value-based payment transformation. To launch a successful value-based payment program, practices must implement a variety of foundational pieces. It may take time, resources and data before a practice can successfully engage in VBP.

In this blog, we'll cover what goes into VBP and its potential benefits. We'll also dig deeper into practice advancement strategies and how they can help you achieve your practice goals.

What goes into VBP?

Many practices want to implement VBP because of its payment structure and return on investment. Yet, they might not consider how to nurture a successful VBP program in their organization. It starts with a gap analysis regarding people, processes and technologies. It’s important to celebrate what is working well and intervene where improvement can be made.

Successful VBP starts with the practice team. There are many perceptions vs. realities that exist within organizational cultures to address, including:

  • Do we clearly communicate our goals?
  • Does everyone in my system understand and take accountability for their role?
  • Are we addressing barriers to change that individuals are facing?
  • Do we break down silos between our clinical and clerical workflows?
  • Are the “whys” as important as the “whats” to enforce engagement?

Leaders building toward VBP engagements must perform change with their teams, not to their teams. Participating in a value-based contract doesn’t guarantee immediate money flow. It requires a lot of work to build a culture to foster the outcomes of a value-based contract.

Second, teams must look at their workflows.

Outlining processes can be an eye-opening experience for the team when thinking about:

  • Are there standards in place regarding frequency, ownership and reason for the duties we carry out daily?
  • Does the entire team perform roles consistently and thoroughly?
  • Do we build workflows with input from key utilizers/stakeholders?
  • Do we collect and document information in the correct fields, from start to close of a visit and in-between?
  • Do we have policies to provide structure and repeatable processes?

Having consistent processes leads to meeting goals. The subject matter experts should play a major role in creating policies as their input is invaluable. Also, this is the time to create buy-in and discover deficiencies.

Lastly, explore technologies and statistics. Many practices implement electronic medical records and don’t realize that there are unused functionalities at their disposal. Things to consider are:

  • How do our reports pull information and are we documenting appropriately to ensure our reports represent our efforts and outcomes?
  • Are there templates and alerts that need to be implemented?
  • Do we need further training with our technologies?
  • Are we optimizing the tools and templates?
  • Have we analyzed, and more importantly, interpreted data to assess our baseline and tell our current story and where we would like it to go?

Technologies can make or break a VBP program. It’s important to gain a broadened knowledge of available technologies to maximize optimization and achieve accurate and actionable results.

6 Benefits of value-based payment models

There are many benefits once you do start participating in VBP. VBP allows organizations to:

  1. incur payments for meeting certain benchmarks regarding patient experience and quality of care;
  2. focus on care gaps and act more proactively;
  3. tackle patient needs by developing partnerships with medical professionals, community resources and behavioral health specialists;
  4. be fully aware of and understand their patient attribution and their total cost of care;
  5. take interest in bringing their coding and documentation to the highest degree of specificity, best representing the risk stratification of their patients; and
  6. think of new interventions based on meeting the patient where they are, from medical to social and behavioral health needs, combined with evidence-based guidelines to move the needle forward. This is the opposite of traditional fee-for-service payments, where you get paid for services rendered and volume of patients seen.

What are Practice Advancement Strategy services?

Now that you know about VBP and the benefits of participation, what steps can you take to engage in a value-based contract?

To participate in a value-based contract, you'll need to create a framework based on foundational pieces. Then, you'll take what you've created and propose it to an insurance company and sell your value mission. In theory, this sounds simple, but many practices are fearful of the entry point of a value contract. That's where Practice Advancement Strategies can help.

How PAS can help your practice

You can think of PAS as another tool in your toolkit. The programs on which DataGen provides guidance are all foundational pieces of successful VBP arrangements or engagements, specifically, value-based care consulting and medical practice consulting services.

For example, DataGen's team of experts will help decipher your practice data to find opportunities to build your framework. They’ll analyze data to craft your value proposition and help define your practice goals and the pathways to reach them. This way, your organization can best position itself for insurance companies from a data perspective.

If you’re participating or looking to participate in National Committee for Quality Assurance programs such as Patient-Centered Medical Home, Patient-Centered Specialty Practice or Health Equity/HealthEquity+, DataGen will help to achieve, sustain, crosswalk and build your success from that foundation. Our experts can help find areas that overlap to streamline participation in both VBP and NCQA.

"We get creative quickly and think about interventions when things are not looking the way they should," says DataGen's Mandi Diamond. "Or, if the data are not reflecting what’s happening, that's when we do a deeper dive and engage the technical vendors and say, 'We're documenting here but our reports are showing X. Where's the gap? What's happening?'"

Because there are multiple layers of a value-based arrangement, and increasing opportunities, DataGen is constantly absorbing information on the latest programs from NCQA, the Center for Medicare and Medicaid Innovation and other sources to provide the best guidance. Our experts are also NCQA-certified in PCMH and seasoned in PCSP and HEA/HEA+ transformation.


How does PAS support payment reform?

Practices that want to participate in VBP will find it more difficult without a culture shift. That’s why having an expert to walk you through these requirements and educate you on important aspects is essential.

"I know some people call that [shift in organization culture] the fluffy part, but it really is so important because if it doesn't start with the people in the practice, it's just going to hit a wall," explains Diamond. "It's a bigger picture. So really dispersing that knowledge and not only saying, well, what do we have to do, but why do we have to do this? That's how you get the buy-in from the team."

DataGen will analyze your contracts or goals and find ways to incorporate essential cultural change. This is particularly helpful if you're pursuing other programs like NCQA. Together, all these pieces will strengthen your practice and help you reach VBP and NCQA goals.

Level up your VBP care: DataGen can help

As we mentioned, there are a lot of benefits to participating in VBP. However, getting to a place where you can be a part of VBP takes considerable practice transformation. It also takes a lot of patience and understanding to achieve a solid foundation used in your value-based contract. That's where DataGen's value-based care consulting can help.

Our experts will take the time to ensure you're on the right path toward delivering high-quality, patient-centered care. Contact us today to gain powerful VBP insights. 

Comments

Popular posts from this blog

BPCIA: 4 fast facts for a successful Model Year 7 kickoff

Participation in Model Year 7 launched on Jan. 1, 2024, with the first few months being a critical time for providers. New Bundled Payments for Care Improvement Advanced Model (BPCIA) participants got their footing, and continuing participants were able to change their clinical episode service line groups for the first time since 2020.  If you’re a provider participating in this model, read on for a BPCIA refresher and four fast facts for starting MY7 right. We’ll also cover core analytics activities to support your clinical and operational success.   4 Fast facts on BPCIA Model Year 7  1.   Focus on clinical episodes and episode volume  Before MY7 began, providers used historic baseline data provided by CMS to evaluate which CESLGs they would go at risk for, ensuring there would be sufficient episode volume. Large episode volume (100 episodes/year or more) reduces random variation and helps protect providers from financial risk associated with outlier Medicare episode spend.    During