Employers and payers can work together to support investment in data and care team infrastructure, leading to cost savings, happier clinicians and healthier patients – any administrator’s dream.
7 Steps to succeed in Value-Based Care
Embrace these steps to improve patient outcomes and create a sustainable model within the value-based care framework.
1. Identify your patient population
- Understand your patients: Particularly those at high risk for hospitalization or emergency room (ER) visits.
- Focus on patient-centered care: Empower physicians to spend adequate time with each patient.
- Refine risk adjustment: Account for the varying levels of sickness among patients to tailor care appropriately.
2. Leverage data and technology
- Collect and analyze data: Track patient outcomes, costs, and risk to identify health trends and manage bundled payments.
- Enhance data sharing: Improve integration across health systems to facilitate better data sharing.
- Invest in technology: Invest in software and train staff to report on metrics, including mortality and readmission rates.
- Keep accurate documentation: Use technology to assist clinicians and coders in coding patient risk factors and tracking data to aid in financial forecasting.
3. Foster a culture of collaboration and automation
- Utilize collaborative tools: Implement workflow and care management tools that encourage cooperation between payers and providers.
- Try cloud computing: Utilize cloud technology for seamless data sharing.
- Automate processes: Streamline tasks such as claims processing and patient workflows to improve efficiency.
- Revamp clinical workflows: Update existing workflows and data management systems to enhance overall performance.
4. Prioritize staff education and training
- Provide comprehensive training: Familiarize staff with new protocols, metrics and care coordination strategies. A well-informed staff delivers high-quality care.
- Address staffing needs: Invest in roles such as population health managers, patient care navigators and case managers to strengthen care coordination.
5. Implement coordinated care
- Communicate effectively: Ensure clear communication to facilitate coordinated care and efficient information exchange.
- Manage panels: Identify patients by their risk levels, proactively addressing their needs and closing care gaps.
6. Measure success with outcome-based metrics
- Focus on key metrics: Use metrics that assess efficiency, effectiveness, timeliness, access and safety to gauge success.
- Overcome data challenges: Address siloed data and manual processes. Patient data is essential for evaluating performance against benchmarks and identifying areas for improvement.
- Define clear performance metrics: Establish actionable metrics aligned with value-based goals. Regularly review these metrics to enhance care strategies.
7. Ensure financial health
- Payment attribution: Determine the patients and medical costs for which providers are responsible.
- Benchmarking: Set targets to compare spending over time. Unlike fee-for-service models, VBC ties compensation to outcomes, which may lead to financial fluctuations.
- Quality performance impact: Assess how quality metrics affect payment structures, ensuring accountability for performance.
- Risk management: Explore shared savings programs or risk-sharing agreements to mitigate risks associated with financial fluctuations.
Regulatory and policy hurdles
- The Centers for Medicare & Medicaid Services (CMS) Interoperability & Prior Authorization Final Rule of 2024 requires payers and providers to improve data-sharing capabilities with the goal of improving patient care and reducing administrative costs by 2027.
- CMS has set a goal for all Medicare fee-for-service beneficiaries and a vast majority of Medicaid beneficiaries to be in a care relationship with a provider who has accountability for quality and total cost of care by 2030.
VBC tools and resources
Humana is committed to providing you with the resources and support you need to succeed in value-based care.
Innovative reporting platforms
Our Population Insights Compass tool is a centralized reporting platform that enables providers to adopt a holistic view for treating patients.
Address access to care
Humana Community Navigator®, our free resource directory, connects patients and providers with financial assistance, food pantries and transportation resources.
Improve patient care
Improve your Star practice quality and strategy with tipsheets, screenings and guidelines designed to support your treatment plans.
Monthly learning series
Humana education teams host webinars covering topics from annual wellness to care coordination, with opportunities for continuing medical education.
Readiness assessment tool
Sign in to gain access to our readiness assessment to understand your current value-based care capabilities.