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What You Need to Know About Value-Based Care

Sustaining and growing your independent New Jersey primary care practice

Summary: The future of primary care is in value-based care, which prioritizes quality over quantity, improving outcomes and reducing cost, and increasing patient and provider satisfaction. Vanguard Health Solutions is the proven regional expert on value-based care, helping to fill the gaps for independent primary care practices in New Jersey that are ready to make the transition from fee-based to value-based care.

Value-based care in primary care is the core of better health and reduced costs for the patient and sustainability for independent primary care practices. We know that from personal experience. Vanguard Health Solutions emerged from the success of the value-based restructuring of our own primary care practice, Vanguard Medical Group, now a client. We’ve seen firsthand the difference that value-based care can make, and we want to share our expertise with other like-minded primary care practices in New Jersey.

 

Our successes:

  • Level 3 in Quality for Horizon Value-Based Program

  • Positive Shared Savings results in VBC contracts

  • New Jersey Comprehensive Primary Care initiative (CPCi) champion

  • Positive Merit-Based Incentive Payment Program (MIPS) adjustment (reimbursement increase) every year since its adoption

 

Value-Based Care Basics

 

What is value-based care?

Value-based care is a model of care where providers are compensated based on the quality of care provided. This is different from fee-for-service care, where we are paid by the number of services. Because value-based care is based on quality, not quantity, it helps to:

 

  • Improve the health of your patients and overall population health

  • Reduce the cost of healthcare for patients and the financial burden for practices

  • Streamline practice efficiencies so that you can do your job better and more effectively

 

Examples of value-based care

As a primary care provider, you may already work with value-based care models. The Centers for Medicare & Medicaid Services (CMS) has introduced value-based care programs, such as accountable care organizations and shared savings programs.

 

  • Accountable care organizations (ACOs) are a network of providers that coordinates care for Medicare patients. ACOs come with varying levels of risk where providers may receive positive or negative adjustments to their reimbursement based on quality metrics.

  • The Medicare Shared Savings Program offers different options for setting up ACOs.

  • Bundled payments are a single payment that covers care over a certain period. This is a fixed amount for all of the services that a practice will provide to the patient.

  • Patient-centered medical homes coordinate care through the primary care physician, including specialist referrals, hospital, and rehabilitation care.

 

Value-based care may be structured in the primary care setting for all patients, including those at greatest risk for chronic disease and who do not qualify for Medicare or Medicaid.

 

How does value-based care help you provide comprehensive coordinated care?

In value-based care, you are incentivized to use evidence-based medicine to provide comprehensive coordinated care that is both appropriate and effective.

 

  • Care is coordinated through the primary care provider, the patient’s “medical home.”

  • Patient health records are shared and analyzed via a robust IT platform.

  • You track and report on patient engagement, preventive care, treatment, hospital admissions/readmissions, adverse events, post-acute care, rehabilitation, and other metrics.

  • You increase patient engagement, utilize population health management tools, and leverage technology.

  • You are paid for patient health outcomes, such as your patient’s effective management of chronic disease.

 

Value-based care puts patients and providers ahead of insurance.

We believe strongly that the care a patient receives should be determined by the medical team and not by insurance companies or hospital systems. Value-based care allows us to do this, putting the patient first and the care in the hands of the provider.

 

  • With value-based care, there are no unnecessary services.

  • The ultimate goal is patient health, which results in improved patient satisfaction.

  • In the process, providers achieve efficiencies and can deliver better care.

  • Patient outcomes are correlated with payment, resulting in more understandable patient bills.

 

Value-Based Care Reimbursement

 

Why do we need to change the fee-for-service payment model to value-based care reimbursement?

Under the current industry standard— the fee for service model— care can be fragmented, inefficient, and expensive. Providers are compensated via an antiquated coding system that tabulates the number of tasks completed. It is an assembly line approach where the patient’s welfare takes a back seat.

 

Healthcare is expensive and getting more so each year.

“National health expenditures are projected to grow at an average annual rate of 5.4 percent for 2019–28 and to represent 19.7 percent of gross domestic product by the end of the period.” (Health Affairs magazine, March 2020) The current system is not working.

 

Shared savings and shared risk are two sides of value-based care.

When you meet the goals in value-based care, you enjoy the financial reward. When you miss the benchmark, you assume the loss. Depending upon how you structure your value-based care model will determine your potential for earnings.

 

Overcoming the Barriers to Value-Based Care

 

What can you expect in the transition to value-based care?

One of the reasons why everyone isn’t already engaged in value-based care is the current system is not set up for it. Historically, the healthcare field has worked within a fee-for-service framework. The transition from fee-for-service to value-based care has been called one of the greatest challenges facing primary care today.

 

Barriers include:

  • Lack of resources—Your practice may be short-staffed, or staff is already overburdened. The transition could be seen as time-consuming and expensive.

  • Technology incompatibility—As technology continues to evolve, your system may be unable to integrate with other platforms.

  • Difficulty collecting and reporting patient information—Your system may not currently be set up to collect the data that you will need.

  • Financial risk/unpredictable revenue—If you haven’t tried the value-based care approach, you may be concerned about how well it will work for your practice.

  • Changing governmental policies—Medicare and Medicaid continue to adjust their programs. Staying on top of any changes will be important to succeed in value-based care.

 

Harness the resources of Vanguard Health Solutions to thrive in value-based care.

VHS was formed to help fill the gaps for independent primary care practices in New Jersey that are ready to make the transition from fee-for-service to value-based care.

 

  • We have the technology infrastructure for seamless transmission and integration of electronic health records (EHRs) into population health analytics. We house vital claims data to help you choose the areas where you need to prioritize.

  • We have the staff to support your needs for statistical analysis of patient care.

  • We can provide the metrics, key performance indicators (KPIs), needed for you to make informed, data-driven decisions in patient care.

  • We can negotiate payor contracts to optimize profits and reduce financial burdens.

  • We offer customized workflow optimization.

  • We keep you apprised of changing government policies to allow you to nimbly pivot without wasting valuable resources.

  • We offer the unique perspective of our clinical pharmacist to help your practice reach its shared savings goals.

 

Key Takeaways

 

Value-based care in primary care will:

 

  • Fill in the gaps in care among our most vulnerable patients.

  • Streamline recordkeeping for seamless transmission, analysis and reporting

  • Improve outcomes, reduce costs and increase patient and provider satisfaction.

  • Establish payor contracts that optimize profits.

  • Meet governmental regulations and guidelines.

 

See our Services page for more information about Vanguard Health Solutions or request an exploratory call with a VHS specialist today by calling 973.559.3701,  emailing info@vanguardhealthsolutions.com or submitting a form on our contact page.

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