7 Keys to Success in Value-Based Care
7 Keys to Success in Value-Based Care
Wellvana assigns a Practice Transformation Specialist to each partner in order to be the boots on the ground and help guide providers into value-based care.
Value-based care doesn’t work if providers remain fastened to old fee-for-service ways. We find that behavior change is one of the biggest roadblocks to unlocking the value in high-quality primary care.
The basic tenets of practice transformation are not a trade secret. Here are the highlights.
Access to same-day sick visits — This builds trust and loyalty with patients. But it’s not easy for busy practices. Competing priorities and staff shortages often tempt practices to push the phones to the answering service early as a solution. It’s important to field all calls up until closing time and make room for these acute visits. Otherwise, patients end up being treated for something simple in an emergency room.
Reducing unnecessary ER visits — Sometimes the ER is precisely what a patient needs. Often, it is not. A 2021 report from Accenture estimates $47 billion in unnecessary care is provided by ERs every year. It’s hard to blame patients who go there for healthcare when they can’t get in to see their provider for weeks or months. Making it easier to get in for an emergent office visit or providing telemedicine options for your patients will help triage “true” emergencies and those that can be treated in the office or over the phone.
Avoiding readmissions — A patient is most vulnerable during the first 72 hours after hospital discharge. New medications or new home health needs often cause confusion for a patient and their caregivers. Catching problems or navigating new habits within the first three days goes a long way in keeping patients from going back to the hospital. Additional monitoring and education for patients with newly diagnosed chronic conditions by the office clinical team is also helpful.
Managing discharge facility options — In a value-based setting, the provider is the quarterback of care for the patient. When a patient can’t be discharged to their home after a hospitalization (for example, needing additional physical care when they live alone), providers’ offices should have a familiarity of the cost and quality of local skilled nursing facilities and rehab locations. Sometimes there’s a better alternative, like having a nurse checking in every day or even making house calls. Diligence and a thoughtful plan for your newly discharged patients determine the success of their recovery.
End of life discussions — This is a polarizing topic in many families. Discussing end of life expectations and wishes ideally should begin early in the relationship with the value-based clinical team. These discussions are difficult. Reach out to your local hospice organization or engage with a Five Wishes program for help. Assist patients by documenting their “wishes” in their chart. Even provide mandatory state-specific legal documents. Make these documents easy to find by preparing a packet for your patients and their caregivers.
Respect specialists — Collaboration is necessary in healthcare and communication is key. Primary care providers need specialists to support the overall care of the patient. But there have to be boundaries. In value-based care, these boundaries are called referrals. Referrals tell the specialist what questions need answering. The returning consult note is the response to the question. Be the patient’s advocate by communicating specifically what information is needed. And if specialists ask for additional tests and visits, evaluate each request before signing off.
High quality office visits — Make the most of every minute. Prepare clinical charts, review consult notes and lab results, and ask patients to bring in ALL their medications for reconciliation. Make the check-in process smooth and be sure everyone leaves with a follow-up appointment.
This is a lot to take on, so go one step at a time and pick a good partner to help you. And remember that as you transition to value-based care, you should no longer have to see 40 patients a day. What if you could see half the patients, provide more personalized treatment with better outcomes, and make more money?
That’s value-based care.