Value-based care (VBC) promises a healthcare ecosystem where patient outcomes drive financial success, quality care is rewarded, and total costs of care are reduced. However, the path to realizing this vision can be challenging and even overwhelming for healthcare organizations.
Obstructing their path to embracing value-based care is a lack of staffing and resources, gaps in interoperability and availability of data, and a complex reimbursement system. Many healthcare organizations struggle to clear the way in a manner that is cost-effective and non-disruptive for clinicians, but they do not need to navigate the transition alone.
Just as VBC is an inherently collaborative approach to patient care, collaboration with the right partner can remove the barriers that stand in the way. Together, it is possible to overcome these challenges and enable all stakeholders to benefit and thrive in a VBC environment.
Key Challenges Faced by Healthcare Organizations in Transitioning to VBC
1. Care Delivery
The switch to VBC needs a proactive and coordinated approach to patient care, moving away from the traditional reactive care model. For organizations going from a traditional fee-for-service model this may require a cultural shift toward patient-centered care. Organizations may face resistance from staff due to concerns about financial risks and changes in clinical practice.
Achieving this shift requires effective communication, collaboration, and care coordination, which can be difficult in fragmented healthcare systems and across different care settings. Rather than individual services provided, clinicians must now focus on the quality of care and patients’ long-term health and wellness.
In value-based care models, it is critical that patients are active participants in their own care to drive optimal outcomes. Engaging patients, especially those with low health literacy or who lack access and resources, can be challenging and requires new approaches to communication and education.
2. Payment Structure
VBC involves risk-based contracts, which inherently introduce uncertainty and financial risk to reimbursement, especially in the early stages of implementation. Rather than the volume of services provided, VBC ties payments to patient outcomes, rewarding clinicians for high-quality, efficient care.
Ensuring accurate data collection to support risk adjustment, various quality metrics, and meeting reporting requirements is challenging, especially as metrics differ across payers and contracts. Organizations must carefully manage cash flow as they transition to a less predictable revenue stream and may also experience delayed payments. Staying in compliance with regulatory changes, such as transition from CMS-HCC Model V24 to V28, can be resource-intensive and require extensive clinical documentation to maximize potential reimbursements.
3. Supporting Infrastructure
Many organizations face challenges with EHR systems, interoperability issues, and insufficient resources. Research from Sage Growth partners suggests that health system and hospital C-suites continue to be largely unhappy with their EHR vendor — and fewer executives than last year believe their current EHR will meet their organization’s needs for the future. The exchange of meaningful health information between different EHR systems continues to face significant operational, financial, and technical challenges.
Transitioning to VBC comes with additional tasks for an already burdened clinical team, such as linking patients to additional resources based on individual needs and goals, monitoring and tracking outcomes across populations, and complying with reporting standards that require more detail than fee-for-service models. Although healthcare leaders recognize the clear benefits of implementing value-based care models, limited resources and staffing constraints hinder the ability to accelerate adoption.
To effectively make the transition to VBC, healthcare organizations need to have robust technological infrastructure in place to support the extensive amount of data and analysis required. In addition to investing in the technology to track performance and drive improvements, there also needs to be the right utilization measures in place. Having the infrastructure support to make sure patients get the right care at the right time is critical to avoid potential risks for exacerbations and complications.
How to Successfully Implement Value-Based Care
Organizations want to enable their care teams to spend more time with patients and less time taking on administrative, clinical, and operational chores. In addition, they need to improve outcomes and reduce the total cost of care.
To create a sustainable future with VBC, the administrative and operational burdens must first be removed from clinicians and staff to free up their time and reduce their mental load so they can enable whole-person care. In order to fully realize the benefits of value-based care on patients and the healthcare system broadly, healthcare organizations must invest in technology, collaboration, and support services.
Leverage Technology
By integrating technology, combined with human expertise, organizations can consolidate information from disparate sources for a comprehensive picture of the patient for risk and quality optimization through:
- Risk Stratification
Advanced analytics to stratify patient populations based on risk factors. This allows clinicians to identify high-risk patients who require more intensive care and monitoring and early diagnosis capture to address risk gaps and create personalized plans. - Clinical Data Abstraction
Extracting important information from medical records increases the data available for analysis used to create actionable insights and code for gaps addressed outside the organization. - Quality Metrics Monitoring
Track performance against key quality indicators using tools and insights to ensure care delivery meets established standards and benchmarks. - Data-Driven Decision Making
Analyze patient data to identify trends, predict outcomes, and provide richer insights at point-of-care to implement targeted interventions to improve care quality and efficiency. - Accurate Risk Adjustment
Analyze patient data to fully capture patient risk factors such as chronic conditions and comorbidities. This helps identify the care needed and ensure accurate reimbursement through precise documentation and coding. - Compliance and Reporting
Ensure risk and quality regulatory compliance without adding additional documentation and review burdens on staff.
Optimize Care Coordination
Provide more connected, proactive care across your population. When resources are used efficiently, organizations can reduce redundancies and ensure patients receive the right care at the right time while controlling costs with:
- Whole-person Care
Care coordination augmentation can scale your efforts, covering more patients, including rising and moderate risk, and proactively tracking and managing a larger portion of your population. - Transitional Care Management
Transitional care management provides support after an inpatient stay for events such as a medical crisis, new diagnosis, or medication therapy changes. Post-discharge support ensures collection of discharge information, medication reconciliation, follow-up scheduling, and adherence monitoring. - Prioritized Member Outreach
Hands-on patient enrollment and navigation increase patient engagement and adherence, promote self-care, and drive behavior change. - Evidence-based Programs
Use comprehensive data analytics to identify needs and target the right populations with evidence-based programs for better clinical and financial outcomes. - Utilization Management
Enable effective cost control and access by assessing the necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. - Closed-loop Referrals
Drive patients to lowest-cost, highest quality settings and bring back data from specialists to the primary care provider for effective patient management.
Enhance Operational Efficiency to Reduce Total Cost of Care
Enabling clinicians with the right tools, resources, and time to focus on the patient is essential to delivering high-quality care. To ultimately improve patient outcomes and satisfaction, healthcare organizations should consider comprehensive solutions to enhance efficiency and effectiveness of care teams through:
- Clinical Documentation Support
Intuitive generative AI supported clinical documentation solutions reduce administrative burden and improve access and clinician productivity. - Pre-visit Planning
EHR-integrated pre-visit summaries present care, risk, and quality gaps in the workflow at the point of care, providing clinicians with all pertinent patient information upfront and helping to close the loop to avoid multiple follow-up appointments. - Medication Management
Prescription renewal support, pre-visit medication reconciliation, and adherence follow-ups relieve clinical staff from time-consuming tasks and facilitate better medication compliance. - Clinical Data Management
Clinical data management and quality measures abstraction increase data in the right fields in the EHR, reducing clinician time spent searching for data and improving coding. - Workflow Optimization
Streamlining and automating workflows reduces redundancies and improves efficiency so that care teams can manage their tasks more efficiently.
Optimize the Transition to VBC with Comprehensive Solutions
Healthcare organizations are rapidly moving to risk-based reimbursement models, at various phases and with varying needs. A partner with deep clinical expertise and the right technology, like IKS Health, can help accelerate the transition to value-based care and increase success in risk-based contracts.
While internal process changes are essential for successful value-based care implementation, clinicians must also leverage external expertise and advanced technology to accelerate transformation. Combining these elements ensures a more effective transition, improving care quality, operational efficiency, and patient outcomes.
IKS Health partners with care teams and clinicians to enable whole-person care by combining the power of technology and expertise, leveraging a scalable and globalized platform, and employing targeted programs to yield outcomes. We supplement your existing resources with a program – tailored to your organization – to help you provide better care and experiences for your patients, improve clinician wellness, and succeed in risk-based contracts.
Discover how collaboration can help overcome the challenges in VBC implementation with IKS Health Value-Based Care.
