Two healthcare professionals chatting at a table

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.
Doctors with their hands together in celebration

Take the next step toward value-based care