A Holistic Approach to Help Providers Transition to Value-Based Care BY S U S A N R I C H A R D S
We should work on our process, not the outcome of our processes. – W. Edwards Deming The objectives of value-based care are overwhelmingly positive. Who could argue with better outcomes, lower costs, and improved patient and provider experiences? However, while clinicians may agree with these goals in theory, actually achieving them requires developing new processes and addressing technology barriers and infrastructure problems, such as interoperability within an already complex healthcare ecosystem.
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Providers spend 27% of their work time on direct patient interactions and 49% on EMR documentation.”
The Centers for Medicare & Medicaid Services (CMS) has a goal for 100% of providers to accept downside risk by 2025. With that date quickly approaching, many provider organizations are concerned about the potential revenue impacts. While these organizations are working to adapt to this new payment model, providers are focusing on making the most of their patient encounters. To address these concerns, Episource has identified three key opportunities for organizations to assist providers in the transition to value-based care delivery models: 1. Before the visit has occurred 2. After the visit, but before the claim has been submitted 3. On an ongoing basis, via health risk assessments (HRAs) By implementing a holistic approach that includes strategies targeting each of these areas, provider organizations can realize savings, optimize care, alleviate administrative burden, and most importantly, give more value to patients.
BEFORE THE VISIT: PREPARING FOR THE PATIENT ENCOUNTER To ensure the highest quality of care, clinicians need context on their patients before the visit so they can adequately prepare to address any health concerns or chronic conditions. While electronic medical records (EMRs) have helped optimize the management of patient data, moving this data between systems is still a challenge. Initiatives are underway1 to build a system architecture that will allow all stakeholders to easily access, analyze, and share this information. With such a system in place, clinicians could access a targeted, pre-visit summary that synthesizes clinical information, enabling them to focus on the most pressing issues. For example, proprietary software that integrates with EMRs could review patient information and highlight conditions that warrant further review. This kind of targeted summary can save providers valuable time, allowing them to focus on clinical care rather than administrative work.
16 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Spring 2022
