According to a 2023 Time report, the unsustainable rising cost of healthcare, combined with the growing sentiment among Americans that the healthcare system fails to meet their needs, is prompting an urgent need for change. The $4.5 trillion US healthcare market is shifting from a volume-based fee-for-service (FFS) care delivery model to value-based care (VBC), which emphasizes quality over quantity in healthcare delivery.
Meeting CMS’ Value-Based Care Goal for 2025
In 2021, CMS established a goal to engage 100% of Original Medicare beneficiaries and a majority of Medicaid beneficiaries in accountable care relationships by 2030. Additionally, CMS aims to have 50% of commercial and Medicaid contracts transitioned to value-based care arrangements by the year 2025, urging healthcare organizations to begin this shift now to meet these targets.
This push is well-founded, as value-based care shows significant promise for patient experience and satisfaction and their quality of care with higher Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores and CMS Star Ratings for VBC compared to non value-based care models, per a Business Wire report in 2023.
However, there are some big barriers to making the shift.
What are the Biggest Challenges in Implementing Value-Based Care?
Implementing VBC within a healthcare organization is a significant departure from FFS care and operating models, and making this shift requires significant time and resource investments. Healthcare organizations must navigate a complex landscape of financial constraints, data management issues, cultural shifts, and more. Understanding the challenges will help enable a successful shift and make value-based care work for all.
Data Management Challenges:
Successful management in VBC requires navigating through diverse complexities and distinct business processes across multiple organizations. Challenges like multiple EHR systems and tech and data interoperability issues can make it challenging to provide a connected, high-quality care network. Data fragmentation prevents the timely exchange of data between clinicians, impedes informed decision-making, and makes achieving desired outcomes more difficult. Healthcare organizations need to invest in a data platform and implement enterprise data management strategies to tackle challenges related to interoperability and data accessibility across disparate systems.
Limited Staffing:
The burden on healthcare professionals, coupled with the growing administrative challenges, insufficient healthcare-focused technology, and inadequate training, continues to weigh heavily on health systems, impacting collaboration in patient care. As per Forbes, the potential shortage of an estimated 3.2 million healthcare professionals by 2026 will further exacerbate the pressure on health organizations. Success in VBC requires clinicians to prioritize “core” tasks directly related to patient care and free up valuable time for meaningful face-to-face interactions to humanize the patient experience. This means that organizations need to figure out other ways to complete the “chore” work–such as clinical documentation and coding.
Physician Buy-In:
VBC shifts financial risk from payers to healthcare organizations, leading to reticence among clinicians to accept potential risks. For effective implementation, clinicians must track patients across their medical journey, both within their own practice and in external settings. This emphasis on holistic care requires clinicians to engage in more extensive tracking and data exchange, in-depth analysis, and comprehensive documentation practices beyond what is normally expected in an FFS environment. Addressing this challenge and getting clinician buy-in involves incentivizing them by aligning reimbursement models with quality care metrics and providing the resources and support to help them manage the additional responsibilities effectively. Care enablement technology solutions provide richer data at the point of care, facilitating early diagnosis capture, improving quality of care outcomes, and ensuring appropriate reimbursements.
Ensuring a Seamless Transition to Value-Based Care with the Right Tools and Expertise
As the healthcare landscape rapidly evolves toward value-based care, the urgency to adapt is high to meet the CMS goals for value-based care arrangements by 2025. Although there are barriers to overcome, successful implementation of VBC, in combination with the right tools, creates an efficient healthcare system that benefits patients, clinicians, and organizations. Tools like enterprise data management solutions and integrated electronic health record systems generate detailed and robust clinical usage patterns and financial analytics to improve care delivery.
Partnering with a company that offers trained clinicians to handle this very important work can help health systems complete administrative tasks faster and more accurately while allowing their staff to provide better, safer, and more efficient patient care. It is all about providing the right care, in the right place, at the right time, and at the right cost, by closely monitoring the patient’s care journey.
Learn more about how IKS Health’s value-based care solutions can guide your organization through this crucial shift with expert support and tailored solutions to make your transition as seamless as possible.
