Value-Based Care Assessment: The First Step to Value-Based Care

Starting the transition from fee-for-service to value-based care is a challenge. Many provider organizations are simultaneously juggling new reimbursement models with old ones and breaking institutional memory to meaningfully move toward changes.

One hospital began its journey to value-based care with an organizational assessment. The value-based care assessment helps the hospital understand which value-based care contracts it is most prepared for and how to balance this transition with existing fee-for-service reimbursement, the director of case management told Insights during a recent anonymous discussion about the division’s latest findings.

Like many provider organizations, this hospital knows the transition to value-based care is coming and might soon be thrust upon them. The assessment is helping it prepare for the inevitable.

“Our hospital is very much fee-for-service with the understanding that we need to start preparing for what’s coming up in the next three to five years,” the director explained. “We do that by continuing to live in fee-for-service but start projects that will not inhibit value-based care.”

“The fear is that there is going to be a point where they’re going to say you’re mandated to go into a couple of value-based contracts,” she furthered.

To avoid this and make the transition on their time, her organization began conducting a value-based care assessment. It will highlight gaps in resources including technology and staff that will enable a successful transition to value-based care. 

After the assessment is completed, the hospital will have a readiness plan that accounts for its continued involvement in fee-for-service. The plan will break down each step along the way, showing which investments must be made at the beginning of value-based care and throughout the journey as the organization balances fee-for-service reimbursement.

“We’re trying to figure out how to align our services and contracts so that we can continue to survive,” the director emphasized. “Financial margins are slim. We all understand what needs to be done, but we need a guidebook to get us there. Here are the steps you need to take now. Here are the steps you need when you’re going to pull the trigger, and here’s what’s coming down the line.”

Her hope is that the assessment will give the hospital a holistic picture of how it can improve, reaching beyond the scope of services it currently provides. One area she hopes to explore further is social determinants of health.

“There are already companies out there doing this at hospitals. We want to figure out how to start to bridge that gap to be successful too,” she explained.

But analytics and data are key elements of this strategy.

“We have very limited data. I do a lot of data mining on my own, which takes a lot of time. In a small organization, it’s expensive to have data analytics. How do we get the analytics in real-time?” the director wondered. “IT and analytics are really big so you can put everything together.”

She has no doubt that a value-based care assessment will reveal the need for more robust IT and data analytics but incorporating these elements requires more than technology. The hospital will need to expand its education, training, and staffing to roll out these technologies and make its strategies successful.

“It’s easy to pull a policy and procedure manual,” the director maintained. “I’m getting a new procedure here at the hospital. I’m going to follow the policy procedure. But how do you manage those patients?”

Greater training and education would allow her team to put these policies into action and understand what it means down the line for patients. 

The educational piece in combination with a value-based care assessment will reveal how her organization can take meaningful and practical steps toward value-based care.

“It’s our responsibility as an organization to know where the tide is going to go and what’s coming in healthcare. We’ve really been talking a lot about next steps to get ready for value-based care,” she concluded.

This interview was conducted anonymously as a part of Insights by Xtelligent Healthcare Media’s research work. Findings from this interview and others are compiled in Choosing the Right Alternative Payment Model report. For a deeper dive into alternative payment models and value-based care success, check out the full report here.