Retooling the Core
Success in a value-based contract depends on three elements that are at the core of any healthcare operation: people, processes, and technology.
People. Value-based care requires teamwork from clinicians both inside and outside the primary care practice. Prevention, early intervention, wellness, and post-discharge care are provided by integrated care teams that include physicians, care coordinators, disease educators, pharmacists, and behavioral health specialists. In a high-performing model, hospitals, skilled nursing facilities, and other ancillary providers all understand and support the primary care clinical model and the goals of improved quality and efficiency, and network partners understand the need to use data to drive continuous improvement and commit to timely communication and data sharing. Transition of care management is most effective with timely notification of admissions and discharges. Hospitals and specialists unwilling to help primary care physicians manage their patients to the best clinical result will be excluded from primary care physicians’ networks. And hospitals that own primary care practices will obtain marginal benefits from such ownership if they do not provide such essential support to the physicians.
Processes. Processes that promote greater coordination of care should be explicitly defined and implemented. Delivering comprehensive, coordinated care requires the use of guidelines and best practices aimed at reducing variation and promoting clinical excellence. Clinical standardization applies not only to physicians, but also to any point of contact within the care delivery system for patients, whether it be a provider, a facility, a support staff member, something less tangible. The way phones are answered, patients are scheduled, and nurses are used to help complete quality metrics each presents an opportunity for reducing variability and improving outcomes.
Technology. Technology can be a lifejacket or an anchor. Technology that integrates data from diverse sources, assists in risk stratification, or improves patient outreach and education is critical for success in a value-based contract. The key for primary care physicians is to use technology that helps drive their clinical models rather than attempt to change their clinical models to fit the capabilities of the technology. Technology should help primary care physicians execute their strategies, not define them. Technology that puts data in the hands of physicians at the point of patient care will create the greatest impact. For example, all clinical notes from the physician, care manager, diabetic educator, and pharmacist are loaded into the electronic health record (EHR) and accessible to all members of the care team at the point of care. Outside claims data also are integrated into the EHR so it can generate alerts to gaps in care, which can be addressed while the patient is present in the office.
Executing the Value: Village Family Practice
Understanding the components of a value-based contract and the work necessary for success is step one; next comes the hard work. Many physician practices struggle to implement the programs, processes, and outreach that truly provide benefits for patients. Identifying high-risk patients does not reduce risk. Hiring a care management nurse does not reduce readmissions. Providing a patient a handout on a chronic disease is not the end of patient education.