Transitioning to Value-Based Care: How Custom Solutions Support Alternative Payment Models

Authored By: Freddy Hernandez

The healthcare landscape is rapidly changing. Fee-for-service reimbursement models that reward providers based on volume are being replaced by value-based care models that focus on patient outcomes and cost reductions. As a medical director, you know firsthand the challenges and complexities involved in this transition. Successfully navigating from volume to value requires new ways of thinking, organizing care delivery, and leveraging technology. In this report, I’ll provide an overview of alternative payment models, discuss the role of custom IT solutions in supporting value-based care, and offer recommendations for choosing the right tech partner to meet your organization’s unique needs.

The Shift Towards Value

Increasingly, public and private payers are embracing value-based reimbursement models like accountable care organizations (ACOs), bundled payments, and pay-for-performance programs. The Centers for Medicare and Medicaid Services (CMS) continues to lead the charge. For example, 50% of Medicare payments are now tied to alternative payment models instead of traditional fee-for-service. Commercial payers are following suit, with 90% offering some type of value-based contract.

The transition is being driven by unsustainable healthcare costs and suboptimal patient outcomes. Fee-for-service rewards providers for doing more procedures and tests, not necessarily for keeping patients healthy. This fragmented care often leads to medical errors, preventable readmissions, and duplication of services. Value-based models realign incentives to focus on whole-person care, prevention, and hitting quality metrics. When done right, value-based care improves population health and reduces costs.

Key Components for Success

Transitioning from volume to value is no small feat. Success requires organizational change and developing new core competencies:

• Care coordination across sites and services
• Data integration and analytics
• Financial risk management
• Patient engagement

Technology is the essential infrastructure that enables these capabilities. As a medical director, you need solutions that can break down data silos, provide actionable insights, and seamlessly connect patients and providers. The right tools allow you to succeed under risk-based contracts, improve outcomes, and remain financially viable.

Many healthcare organizations, however, are still relying on outdated legacy systems that were designed for fee-for-service models. These technologies can’t provide the comprehensive data, workflows, and automation needed for value-based care. Attempting to compensate with manual workarounds results in productivity losses. I’ve seen this lead to clinician frustration and burnout.

Custom IT Solutions for Value-Based Care

Off-the-shelf software isn’t enough to support the transition from volume to value. Today’s alternative payment models require flexible, customizable solutions that are purpose-built for your organization’s needs. As you evaluate technology partners, make sure they offer tailored products and services such as:

• Data Integration: Combining clinical, claims, and financial data is crucial for managing populations under risk contracts. You need advanced integration tools that aggregate disparate information into a unified view.
• Analytics: Robust analytics enable you to stratify patients, identify care gaps, forecast financial risks, and track quality metrics. Look for predictive models, customizable dashboards, and real-time alerting.
• Workflow Optimization: Care teams need streamlined workflows that standardize evidence-based practices and boost productivity. Prioritize solutions that automate manual processes and simplify complex tasks.
• Patient Engagement: Keeping patients involved in their care plans improves outcomes and satisfaction. Personalized education, telehealth, and mobile apps that activate patients are key.
• Interoperability: Participating in value-based contracts requires connecting with payers, other providers, and community resources. APIs and HIE connectivity must be built-in.

These examples demonstrate the specialized capabilities required for value-based care. When evaluating potential tech partners, seek out industry experience implementing similar solutions for organizations like yours. Leveraging proven technology accelerates your transformation.

Choosing the Right Partner

Not all healthcare IT vendors are positioned to provide the tailored solutions and strategic guidance you need to thrive under value-based care models. When researching partners, look for the following:

• Experience with value-based care: Ask potential vendors to quantify results they’ve achieved for customers regarding reduced costs, improved outcomes, and financial performance under risk contracts.
• Clinical leadership: The partner should have clinicians leading product development and innovation. This ensures their solutions are designed for frontline workflows.
• Technical expertise: At minimum, the technology partner should have competencies in EHR integration, interoperability, data warehousing, advanced analytics, and modular platform design.
• Services portfolio: To maximize your ROI, the vendor should offer advisory services covering clinical transformation, data governance, change management, staff training, and more.
• IT support: Managing complex population health technology requires robust IT support services including implementation, integration, maintenance, upgrades, and cybersecurity.
• Agile approach: The partner should use iterative development methods that allow for continuous improvement of their solutions based on your feedback and evolving business needs.

The right technology partner becomes an invaluable asset for realizing the triple aim of improving population health, reducing costs, and improving the care experience. Take time to thoroughly evaluate potential vendors against your organizational goals and technical requirements before making a selection.

Getting Started with a Value-Based Care Platform

Transitioning from volume to value doesn’t happen overnight. Rolling out a new population health management platform takes thoughtful planning and execution. Based on my experience, I recommend the following best practices:

• Establish governance for data-driven decision making: A multidisciplinary team of clinical, financial, and technical leaders should guide the technology selection, implementation, and optimization.
• Clean up foundational data: Invest time in reconciling patient, provider, claims, and clinical data across source systems before loading into the platform. This improves downstream reporting accuracy.
• Phase deployments by use case: Start with a targeted high-value use case like readmission prevention or chronic disease management. Build on early wins before expanding the platform.
• Drive clinician adoption: Get input from end users when configuring workflows. Provide thorough training and support as you roll out new population health tools.
• Iteratively improve: Use feedback loops to refine the technology, analytics, and workflows over time. Continuous improvement is key for long-term success.
• Monitor KPIs: Establish baseline metrics related to utilization, quality measures, patient satisfaction, and financial performance. Track progress against benchmarks to demonstrate quantitative results.

The time is now to lay the technology groundwork required for value-based care contracts. I hope these insights help guide your journey. Please reach out if you would like to discuss further how a purpose-built population health platform can set your organization up for sustainable success under risk-based models. I’m happy to offer my perspective and lessons learned from other provider groups. Working together, we can transform the healthcare system for the better.