Motivating Providers to Embrace Value-Based Care: 4 Keys for Healthcare Organizations

For any healthcare organization and provider, the importance of the transition to value-based care (VBC) models is undeniable. To meet the ambitious goal of the Centers for Medicare & Medicaid Services (CMS)—covering all traditional Medicare beneficiaries and most Medicaid beneficiaries by value-based providers by 2030—it’s clear that the entire healthcare field needs to adapt accordingly.

There are significant reasons to be optimistic about the impact that value-based care can have on equity, cost savings, and overall health outcomes. But the transition towards a value-based model of healthcare is challenging and labor-intensive. Not only does it involve changing workflows, procedures, and payment models–it often entails a ‘hybrid’ period where organizations start offering a value-based model while continuing to operate within the conventional fee-for-service model. The need to support both models can result in even more bureaucratic and logistical work.

Another challenge organizations encounter on their value-based journey is the burden of HCC coding. Because value-based care aims to compensate providers based on their impact on patients’ health rather than the quantity of medical services provided, it relies heavily on risk adjustment. By providing increased resources for treating patients with significant health issues, risk adjustment offsets the financial pressure to avoid covering particularly vulnerable patients, thus helping level the playing field among patient populations. But to work properly, risk adjustment requires accurate and thorough coding of diagnoses—a process that is not only time-consuming but also has a significant learning curve.

In the face of these challenges and others, it is essential for healthcare organizations to take concrete steps to deliberately motivate their providers to embrace value-based care. At the same time, they need to ensure that their providers have the tools they need in order to make this transition smoothly and to thrive in the context of value-based healthcare.

To help healthcare organizations adapt to the demands of value-based care, here are four key ways they can motivate their providers to embrace this model of healthcare.

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Prioritize the Training of Clinicians

The major differences between value-based and fee-for-service models of healthcare shape the ways medical professionals do their jobs. Not only are there distinctions in procedures and logistics, but providers may have different mindsets depending on the model in which they work.

Given these differences, physicians and healthcare organizations often face inefficiencies and challenges when making the transition to VBC. It’s crucial for healthcare organizations to invest in education and training programs for clinicians, both initially and then repeatedly as they adapt to the daily realities of value-based care.

Consistent messaging and support are essential here, including recognition of providers’ hard work and sharing positive feedback from patients who are happy with the person-centered care they’re receiving. Professional mentoring can also help, such as sitting down with a clinician, reviewing their recent charts, and together evaluating what they have done right in terms of value-based care and where there is still room for improvement.

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Use Incentives Effectively (and Early)

An incentives program is another powerful tool for engaging clinicians with value-based goals. To be effective, these programs should align incentives with specific activities important to value-based care, creating a reimbursement structure that provides specific rewards for achieving certain goals. Importantly, incentives can also come in non-monetary forms such as time off.

One mistake that organizations often make as they start adopting value-based care is rewarding clinicians too late. Within a typical healthcare organization adopting a value-based model, clinicians commonly spend upwards of a year in service of value-based goals—learning new concepts, putting in extra hours, and changing their routines and workflows—before the organization receives any shared savings. If the organization only starts providing financial incentives at that point, the opportunity to deploy incentives over the course of the clinician’s first year or so in the value-based journey will have been squandered, and with that an important avenue of engagement.

Ideally, healthcare organizations can set money aside for bonuses before they receive shared savings, in order to prevent lag time from reducing the effectiveness of the incentives offered to providers.

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Build a Cooperative and Collaborative Culture of Value-Based Care

To work effectively, value-based care requires a full-team approach that prioritizes patients’ well-being above all else. Developing a clearly defined set of organizational values can be an important step in helping foster this kind of patient-centered workplace culture.

Procedures should also be implemented that reflect these values. Whether it’s a small office or a large organization shifting to value-based care, it’s important to carefully design processes to increase efficiency and collaboration, in order to ensure that patient needs do not slip through the cracks.

One example is conveying to staff the importance of accommodating same-day visits when necessary. Consider the scenario of a clinic at 4:00 p.m. on a Friday, when the clinic’s staff members are eager to go home after a long week, and a patient suddenly calls for a same-day sick visit. In a fee-for-service model, there could be an incentive to send the patient to the emergency room in order to avoid having to pay staff for overtime work. But in a clinic that has fully internalized the principles of value-based and patient-centered care, the mindset should be different, making the necessary adjustments in order to get each patient the care they need, when they need it.

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Help Clinicians Utilize Data Efficiently

Given the importance of collaboration within value-based care, one major challenge during and after this transition is putting the data clinicians have at their disposal to good use–including during patient visits. This can include results from labs, X-rays, and other providers, information from patients, treatment data, and more. In this regard, the sheer quantity of data, and its often fragmented nature, pose a major challenge to clinicians eager to put it to use, especially at the point of care.

Health data is also critical to helping ensure that HCC coding is both accurate and complete. By making sure that all diagnoses are reflected in patient records, reliable HCC coding can prevent a situation in which inadequate risk adjustment leaves healthcare organizations lacking the resources to sufficiently compensate providers for the care they deliver. In addition, data should be used to help clinicians understand how well they’re performing and what steps they can take in order to be more successful in the future.

It’s important to focus on clear and effective data delivery, in a way that’s easy for clinicians to understand. Artificial intelligence (AI) can make a powerful difference in this regard. Having access to a platform that interprets complex patient data coherently and in context, and provides actionable diagnosis insights, allows physicians to assess and act on their patients’ health status at the point of care.

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The Big Picture

Given the importance and scope of the shift towards value-based care, it’s no surprise that it is both a complex and labor-intensive process. Not only does the transition itself present serious challenges, but it often entails adopting a hybrid model, with many healthcare organizations working simultaneously in both fee-for-service and value-based programs. This can result in significant hurdles, both in terms of logistics and in terms of the mindset of healthcare providers.

To make this transition as smooth and successful as possible, healthcare organizations need to ensure that clinicians are both motivated and able to adapt to the realities of value-based care. Achieving that goal requires the right combination of training, incentives, workplace culture, and data-driven tools. By emphasizing these four pillars, healthcare organizations can help themselves, their providers and their patients thrive within the context of value-based care.

This article was originally published in Healthcare IT Today.