The journey to value-based care is well underway, and while many providers still operate under fee-for-service reimbursement arrangements, the switch is inevitable for scores of hospitals and physician practices. Reimbursement will soon be tied to quality rather than volume, and providers need to be ready for the transition.
As with so many other areas of healthcare, the appropriate use of technology will play an important role in the switch from volume to value. Using modern tools and processes will help to solve two primary challenges: How to quantify and demonstrate value, and how to incorporate that into the practice to ensure patients are indeed receiving quality care.
Amy Leibensberger, a physical therapist and director of data integrity for naviHealth, said a good place to start plotting the journey is the Centers for Medicare and Medicaid Services, which has provided a kind of rough roadmap for organizations looking to quantify quality in particular.
"They have truly helped identify what the quality components are of the value-based care equation," Leibensberger said. "Then you can add some components to that -- change over time, function change per day or week, something like that. I encourage (providers) to investigate what's best for them."
THE RIGHT DATA
Several years ago, Leibensberger's practice knew it wanted to collect data on both quality and efficiency. It asked itself some important questions? What data is easy to use, and what can be collected easily? What data points are specific to our patient population? And does the information allow for the granularity of precise measurement?
"You don't need a thousand data points," Leibensberger said. "You just need a very good minimum set. You've got to know your patient population and where you are going, what you want to measure."
The next question for an organization is how to incorporate all of this information in a way that allows for changes in practice patterns. It's about turning data into knowledge, and applying that knowledge to patient care. It's the core reason for transitioning to value-based care.
Luckily, turning data into knowledge isn't quantum physics. Once an organization has its data and is able to analyze it, it can then pinpoint opportunities for changing the practice to improve efficiencies without compromising quality outcomes -- and for improving patient care overall. There's a balance to be struck; Leibensberger said it's important to address both of those components.
Technology is becoming more and more essential in achieving those goals. The simplest example is having a form of data collection that allows an organization to look back and quantify everything. Otherwise they're stuck doing things manually.
Tech allows for consistency and ease of data collection, and it can also be used at the point of care so you're not analyzing data after the fact and saying, "This is what we should have done better."
"Before I had any type of tool, I'd give the best idea for care planning based on my experience and the patients I had seen," said Leibensberger. "With tools and technology now, what we're able to do, especially in predictive models, is we're able to give them patients that look into the future."
A solid tech framework eliminates the guesswork, and also can provide actionable data quickly -- on day one or two instead of day 10.
"You're aligned," said Leibensberger. "In the past, that hasn't always been there. You're able to provide much better patient care."
Is the switch from volume to value possible without technology? Sure, said Leibensberger. But it would be extremely laborious and imprecise.
"You don't have to have every piece of technology," she said, "but it definitely enhances the ability to become more effective, quicker, and more precise about our plans for our patients."
When developing tools for better patient care, a key element is adjusting the outputs, and knowing that the technology or tool is providing appropriate care guidelines and decision support. The decision support component is critical: The tech isn't supposed to tell the practice exactly what to do, but instead but instead illuminates the best paths forward.
"If your mom has a fractured hip and need all her activities monitored, and in addition she has congestive heart failure, I don't want to compare her to stroke patients because she's an orthopedic patient," said Leibensberger. "And she has COPD, so I don't want to compare her to patients who broke their hip playing tennis."
Of course, in order to harness all of this data effectively through technology, a hospital or practice has to make an investment -- but exactly how much depends on a number of different factors.
"Let's say a skilled nursing facility wants to assess where they are," said Leibensberger. "What resources do I have? Do I have the staffing resources? Where are we with our ability to collect the data? Do a full analysis of what you have as far as nursing resources, therapy resources -- those would be some of the basics. And then from that … it's a full assessment of where you are now. Then you determine, 'This is where CMS wants me to be.'"
The move to value-based care is to be embraced, not feared, said Leibensberger. Ultimately it incentivizes clinicians to provide the best possible care for their patients, which is what it's all about.
"The journey toward value-based care started many years ago, and I'm extremely pleased that all of the stars are coming into the same constellation," she said. "Policy, payment and practice are all guiding us toward the best value-based care. It's a good place to be."