Dealing with the current COVID environment has consumed our immediate focus in the healthcare industry, making it almost easy to forget that before COVID hit, we were all embarked on a major philosophical and operational shift from the old Fee-For-Service model of healthcare delivery to the approach of Value-Based Care.
Leading a change of this magnitude takes time, which is often the most critical resource for a provider practice. As a former Practice Transformation Coach, I found that it was often the case that the lack of that resource – time – led to frustration for practices, ultimately impacting Value-Based Care performance. In my experience, a key element of Value-Based Care performance is in-practice support and technical assistance. It’s rare that practices and providers aren’t willing to change; the real problem is that they don’t have the time and capacity to start doing work in a different way.
Recently, Harvard Medical School in collaboration with United Healthcare published a study called “A 3D Model for Value-Based Care: The next frontier in financial incentives and relationship support.” In the study, they identify a third critical component to Value-Based Care beyond quality improvement and cost reduction incentives: Infrastructure Support.
The study identifies infrastructure support types as:
- Raw data
- Analyzed data
- Technical assistance
- Access to care management and tools
- Risk management support
- Infrastructure payments
The Harvard study notes that “infrastructure supports are not a new feature of payer-provider relationships but deserve attention because they may be critical to the success of Value-Based Care arrangements.” While all of these infrastructure support types are important, they may fall flat without provider engagement.
Of particular note in the list above is “technical assistance.” What onsite technical assistance does – (such as that provided by a third-party partner like Medical Advantage) – is provide practices with dedicated and targeted resources aligned with program requirements. With clients I have worked with, this type of resource has always driven performance above and beyond where the metrics were without that support.
There is an overload of constituents and programs in Value-Based Care, and technical assistance absorbs that complexity to provide a more concise set of steps to be successful. Every day practices manage information and requirements from at least a dozen different health plans, a dozen different technology systems, and a dozen different programs, and often those mandate confusing and conflicting advice to do better. Practices need support to globally address the requirements being placed on them, and focus that into fundamental change.
Now a caveat to that is that the technical assistance should never add to the burden and requirements placed on the practice. There is a balance of supporting change while reducing the burden. Prescriptive programs for change often can’t accommodate the variance that occurs between independent solo-practicing provider sites and large owned multi-specialty sites, for example. Trying to implement a single strategy for change across those different practices does not work.
Identifying the right changes can help providers develop the capabilities needed to deliver on various contractual requirements. Many times, I have visited a provider office to see stacks of data and reports on a desk. Practices can have access to data and systems, attend webinars and medical management meetings, but still, without the time to implement change, without the time to sit and analyze the reports, without the time to track specific program funds, the change doesn’t occur.
Identifying areas is one step, then taking recommendations and prioritizing them according to an organization’s needs is the next, then lastly moving into technical assistance support to help drive and implement change. Those changes, in turn, start increasing revenue through reduced costs, improved quality, EHR optimizing, and workflow efficiencies. Once the money from savings starts coming in, that helps to go further in advancing Value-Based Care arrangements.
One of the other technical assistance components of the Harvard Study I was pleased to see was that of “infrastructure payments”. I have seen great success in provider organizations and practices when payers institute administrative payments. This allows providers to have a dedicated and set budget to use for support. Providers and organizations who invest in onsite support typically enjoy a substantial ROI. As Value-Based Care programs evolve and develop, it will be important for payers, organizations, and providers to consider setting budgets to accommodate onsite technical assistance for providers. There are a variety of ways to allocate funds for that, but to date, it is often an overlooked approach.
In the practice support work I do, it’s important to provide practices with the tools to become successful and be the voice of the practice with different insurance companies. With access to infrastructure and resources, providers don’t get buried and burdened by various program flaws (attribution issues, the data didn’t load (etc., etc., etc.); rather, providers can continue their work with their patients and are dedicated to continuing their journey to value-based care through the models. The technical support is important because engaging with Value-Based Care to improve care quality and lower costs is not easy for certain providers. I firmly believe that when practices have onsite resources that are an extension of the office, it reduces the burden, while simultaneously improving performance and efficiencies.
Changing processes and delivery strategies takes dedicated focus, and Value-Based Care programs will need to more readily engage in supporting providers through that change outside of financial motivation, or the frustration and false starts will continue to slow the onset and success of good Value-Based Care models. Without other key elements like trust, vision, skills, resources, and action plans, there will be ongoing resistance, confusion and anxiety. As payers and providers continue to enter into advanced payment models, it will be important to step back and address barriers to successful Value-Based Care adoption so far.
To learn more about how Medical Advantage can assist your practice in reaching Value-Based Care goals and success, contact us today.