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4 Countries – 1 Focus on Value Based Care

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We like value based care and the promise it holds for patients. That’s why we were intrigued when we saw a news article this week headlined, “Global Foundation Launches Value-based Healthcare Pilots”. The World Economic Forum is going to launch pilot programs in four different countries this year that will show how “…value based healthcare could track and pay for treatment based on how well it works rather than the volume of care.” The pilot is being launched in response to rising costs and dissatisfactory patient outcomes across the globe. We say that’s a welcome pilot program.

The “Value in Healthcare Project”

It’s called the “Value in Healthcare Project” and the first pilot is being set up right here in the United States in Atlanta, Georgia. The project is working with 20 organizations across the care continuum – payers, providers, suppliers and government organizations – to build a value-based approach to heart failure in that area. First, the team will create their own roadmap to determine exactly what value-based care for patients with heart failure looks like. Then they will get to work implementing those recommendations to see if it will indeed affect outcomes.

The Value in Healthcare Project is going to set up three more regional pilot programs in 2017 in the Netherlands, Singapore and the People’s Republic of China.

Establishing goals and providing support for value

The project is looking to set in place three pillars, or “foundational principles” that will form the basis for value-based care:

  1. Measuring outcomes and costs
  2. Focusing on well-defined patient populations
  3. Customizing specific interventions

Importantly the project also realizes that there need to be support systems for these principles to occur. Without the right type of structured, systemic reinforcement, the reengineering of health systems around value based principles cannot occur. The four key enablers are:

  1. Informatics and the ability to gather data
  2. Benchmarking, research and tools
  3. Payments – including new forms of compensation and reimbursement that help to improve patient value
  4. Improved delivery including giving providers the opportunity to use innovations to better access appropriate care and continuous improvement

The power of improving payment

Let’s stop here and highlight the payment support line item. It is not a small thing that improving payments has been called out as essential to supporting successful implementation of value based care. We know that if physician practices and hospitals cannot find a way to streamline back-end payment systems, innovation slows. Addressing those systems with advanced technology gets physicians back to patient care faster and in some cases can increase revenue by up to 30%.

Note that the line item says “new forms of compensation” and “reimbursement that helps to improve patient value”. We believe that means that a dollar earned is a dollar paid. It means that the parties in the continuum of care need to find a way to reduce administrative burdens on physicians so that they no longer have two hours of administrative work for every one hour of patient care. It also means that providers can be accurately reimbursed for high quality patient care if innovation is employed in revenue cycle management.

Physicians buried by admin

That brings us to the next article that caught our attention this week. An opinion piece in Becker’s Hospital Review Leadership and Management section focused on physician burnout and the role that administrative burdens play. Written by Northwell Health President & CEO Michael Dowling, the column focuses on the fact that due to regulations like meaningful use (EHR) and insurance verification, “physicians are forced to spend more time on administrative duties and less time treating patients. This is a major point of dissatisfaction for physicians, who entered the medical field to help patients, not to do paperwork.”

We couldn’t agree more. As President Dowling said, “Although we cannot fully control the external factors — such as federally- or state-mandated regulations and standards — that contribute to burnout, we can control the practices and structures inside our health systems to give physicians greater authority and a louder voice.”

Let’s get to the business of returning physicians to patient care and get them out from under their desks. Let’s free them from undue administrative burdens by employing the technology available to us today to streamline healthcare revenue cycle management and improve reimbursement. It’s time to start repairing healthcare and that means giving each physician the ability to practice medicine once again.

Infinx4 Countries – 1 Focus on Value Based Care

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