As the world continues to cope with the COVID-19 pandemic and variants of the virus, healthcare organizations, providers, and payers are simultaneously preparing to transition to a new payment reimbursement system termed “value-based” healthcare. This innovative system has big advantages for patient safety and patient satisfaction and is rapidly replacing traditional “fee for service” models. Those old models were built around the method of billing patients (and their insurance companies) for the volume of procedures and services performed.
Rather than billing and accepting payments through a fee-per-service model, value-based healthcare instead incentivizes providers to focus on improving patient outcomes, which includes safety improvements. The “value” is based on comparing improved health outcomes to the cost of the patient care necessary to achieve those outcomes.
But how can you start shifting your organization toward a value-based model? In this article we’ll explore some of the ways you can build a framework for implementing value-based healthcare that prioritizes patient safety at your institution.
How does value-based healthcare work?
As noted, value-based healthcare provides incentives for healthcare providers to focus on patients’ overall health by changing the way care is delivered and payment is collected. Rather than billing a patient for each test or procedure, billing is based on the way treatment impacts a patient’s outcomes.
These outcomes are measured using quality targets and benchmarks, which serve as a guide for organizations to better understand the ways that care can be improved, while also seeking to change how billing and reimbursement work within that framework. Numerous organizations worldwide, such as the International Consortium for Health Outcomes Measurement, are striving to unlock the potential of value-based healthcare by defining global standard sets of outcome measures.
In the U.S. for example, the Centers for Medicare and Medicaid Services (CMS) provides a quality strategy for healthcare organizations to prepare them to move to value-based care. In fact, CMS’ goal is to have almost 100% of its Medicare reimbursements tied to value-based contracts by 2025, although today less than 20% of Medicare spending is value based.
Improving value matters as much as improving safety
The high reliability and continuous improvement that value-based payment systems will require mean that patient safety must be a priority. According to the Agency for Healthcare Research and Quality, “high reliability organizations cultivate resilience by relentlessly prioritizing safety over other performance pressures.”
Along with safety, there are a number of benefits to value-based healthcare, including:
1. Improving the quality of care
By bringing together teams from across the care continuum rather than leaving patients to connect the dots of their own care—for example sending post-operative patients home without a structured plan—patients experience better health outcomes faster and more effectively. This relates directly to safety because it ensures that everyone on the patient’s care team is informed appropriately, and that proper handoffs occur to avoid any potential risks. This open communication eliminates many medical errors, greatly improving the quality of care that each patient receives.
2. Greater patient satisfaction
When patients feel that they have a voice in their care, they are more satisfied overall and perceive the care to be of higher value. Measuring quality provides a snapshot of how clients, patients, and family perceive your organization’s providers, staff, and environment of care. To gauge satisfaction in an ongoing manner, your organization can employ the use of online satisfaction surveys and other means at any time—for example, after a first appointment, or following surgery. Results can be captured and incorporated into reports, and trends become visible so you can take targeted actions to improve the quality of your healthcare organization.
3. Higher efficiency of care and reduced healthcare cost
One major factor in the current high cost of healthcare is the use of a la carte billing, which often results in extra tests being ordered that may not be in the patient’s best interests. Physicians often admit that they order extra tests for fear of missing something in their diagnosis and/or to protect themselves against malpractice lawsuits. By eliminating per-service billing in pursuit of better outcomes overall, your healthcare organization can better correlate the cost of care with the value that care produces for the patient. This distinguishes “price” from “value.”
4. A healthier society with reduced risk
One of the drawbacks to the healthcare systems worldwide is that expenses can cause patients to wait to see a doctor until well after they need care, and their condition worsens. By reducing costs and focusing on positive outcomes for patients, providers can create a healthier society that is less likely to suffer from chronic diseases that are easily avoided with early intervention.
A framework for implementing value-based healthcare
Here are the most important steps to take in establishing a framework to deploy value-based healthcare at your institution:
Focus on a comprehensive solution
Instead of treating the symptoms, value-based healthcare focuses on treating the whole patient. This means implementing care plans that include things like transportation assistance, psychological counseling, and other resources that can improve healthcare quality overall.
To ensure that your care is comprehensive, you can deploy satisfaction surveys, as noted. But other tools include registering complaints and incidents using today’s technology that meets patients and staff wherever they receive care and work, respectively. For example, individuals can report an incident or complaint, submit an idea for improvement, or complete a survey, etc., using their tablet or mobile phone.
Identify patient segments
Rather than organizing care based on providers, focus care on the patient population(s) your hospital or healthcare organization targets in its mission. Within each category, identify key groups (e.g., patients with cancer or diabetes) and organize your clinics and hospitals to provide comprehensive care for these patients in a single place.
Such organization of care might mean restructuring facilities, equipment, and your workforce to ensure that all of the clinicians and specialists that a patient with a given condition needs to see work in the same building.
Measure health outcomes and costs
Your healthcare organization is already measuring outcomes. However, your measurement systems, too, might need to be retooled under value-based care systems. When you’re measuring outcomes, focus on what health means to each patient population. This helps to align treatment goals in specific ways while also providing flexibility from one patient to the next.
When outcomes are measured against the costs of providing services, you can better learn to balance outcomes against billing.
Integrate learning teams
Bringing care teams together isn’t just about convenience. With time spent together, these teams create informal learning groups. As time passes and communication improves, so do patient outcomes. The value of such integration efforts often result in:
- New ideas for improved workflows
- Better and more targeted diagnoses
- Enhanced access to services
- Improved quality of care
- Lower overall healthcare costs
Expand partnerships and peer support
Building partnerships is a key part of value-based healthcare. Partnerships within clinical teams and between clinicians and employers, for example, can increase investment in value-based healthcare, ensuring the financial health of your institution.
Finally, consider the critical role that peer support plays in making teams more cohesive, which contributes to value, patient and staff safety, and satisfaction of all stakeholders in healthcare. Peer support focuses on giving healthcare staff the tools to offer care to colleagues, which helps alleviate anxiety, burnout, or even symptoms of post-traumatic stress syndrome following a healthcare incident. The best help often comes from someone who understands the situation: a colleague.
More information about improving the quality of care
- Download our eBook "Quality Management System" if you want to write an internal business case.
- Our special topic page shows several important elements of quality management
Or learn more in one of our blogs:
- The financial impact of patient safety errors
- Focus on the process to achieve structural quality improvement
- The manager's role in quality improvement
