Does the infrastructure of a practice influence the success of value-based care models?
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No ‘one-size-fits-all’ strategy
Practice infrastructure can be a significant factor in the success of musculoskeletal value-based care models.
Value-based care models aim to improve the quality of health care while controlling costs, often by shifting from fee-for-service reimbursement to payment models that reward health care providers for delivering high-quality, best outcomes and cost-effective care. Effective infrastructure can support these goals in several ways:
- Episode control: Practices that can control the entirety of patient care throughout a value-based care model are better suited to achieve success. Vertically integrated practices have significant advantages competing in these models.
- Data analytics: Value-based care relies heavily on data analysis to identify patient populations in need of specific interventions, track performance and measure outcomes. Practices need robust data infrastructure to collect, store and analyze patient data effectively.
- Population health management and care coordination: Effective care coordination is critical to managing chronic conditions and preventing unnecessary hospitalizations. Practices must have the capability to stratify their patient populations and identify high-risk patients who may benefit from proactive interventions.
- Patient engagement: Engaging patients in their own care is a key component of value-based care. Infrastructure that facilitates patient communication, education and self-management can improve outcomes.
- Quality reporting: Value-based care models often require practices to report on quality measures. Infrastructure should support accurate and timely reporting to meet program requirements.
- Expense management: Shifting to value-based care models can involve changes in reimbursement structures and financial risk. Practices need the infrastructure to manage expenses effectively in this evolving landscape.
- Performance monitoring: Regularly monitoring and adjusting strategies based on performance data are crucial in value-based care. Infrastructure should support real-time or near-real-time performance tracking.
In summary, having the appropriate practice infrastructure in place is critical for the success of value-based care models. It can help practices deliver better care, improve patient outcomes, control costs and adapt to the changing landscape of health care reimbursement and delivery. Based on the discussion above, solo practitioners and small practices might struggle to achieve success in these models unless they have strong collaboration with hospital or health system partners. Conversely, monolithic health systems have the necessary resources but struggle to control costs because of large fixed operating expenses. There is no “one-size-fits-all” approach for a winning strategy, but the emergence of vertically integrated musculoskeletal health systems provides perhaps the best infrastructure to compete on the outcomes and cost variables in value-based care.
David S. Jevsevar, MD, MBA, FAAOS, is CEO of OrthoVirginia in Richmond, Virginia.
Infrastructure can influence success
There are three keys to a successful musculoskeletal value-based care program: the ability to collect data, a clear understanding of costs and consistency in how conditions are treated. If you are missing any of these components, you will likely not have the visibility to drive savings. So, the infrastructure of a practice can certainly influence the success of musculoskeletal value-based care programs.
To be successful, there needs to be the ability to ingest massive amounts of claims data to assess costs, consistency and outcomes in real time. This is where most practices have struggled, and understandably so. Much of the data needed to gauge meaningful savings in value-based care programs may be inaccurate or lack standard definitions. To solve this problem for our musculoskeletal physician practice partners, Healthcare Outcomes Performance Company (HOPCo) has invested more than $125 million into our claims analytics platform. However, HOPCo’s robust information technology infrastructure and subject matter experts are not resources an independent musculoskeletal practice will likely have built into its existing infrastructure.
Next, there must be a willingness for change among physicians to begin utilizing standardized clinical protocols to reduce costs and improve outcomes. Creating change often requires both a shift in clinical practice and culture. As orthopedic surgeons, we are always looking to improve our technical skills, but we also need to begin to look at all aspects of value-based care, including those that are outside of the OR.
Wael K. Barsoum, MD, is the president and chief transformation officer at HOPCo in Phoenix.
Successful human processes are key
One thing we can agree on is that success in value-based musculoskeletal care delivery will require significant change — our conversations with patients, interactions with team members and key performance indicators will all look and feel different if we are doing it right. Certainly, that will require new infrastructure, but I would caution anyone expecting infrastructure to be a knight in shining armor. Technology is effective only when it is built on successful human processes. Patient-reported outcomes (PROs) are a great example. PROs are a key component of successful value-based care models, but adoption has struggled where sophisticated technology was expected to be the solution. In contrast, PROs have been successfully implemented where clinicians had already been collecting these outcomes manually or with basic technology.
Focusing on infrastructure as a primary value-based care strategy risks overcomplicating an already challenging transition. Difficult change may be best accomplished with simplified approaches, as brothers Dan and Chip Heath suggest in their book, Switch. They propose that significant change requires three elements and use the metaphor of riding an elephant. To get the elephant from A to B, you must direct the rider, motivate the elephant and shape the path. The rider is our rationale mind, the elephant our emotional side and shaping the path makes it easier to get there. Their concept as it applies to value-based care transformation highlights the limitations of infrastructure alone in generating sufficient change. Yes, infrastructure is needed to both direct the rider (tell them what to do) and to create the path. However, it is shaping, not creating, the path that is the key element of effective change. Strategic, disciplined use of infrastructure is essential to shape a path people can follow. A critical step in shaping the path is also recognizing the many non-infrastructure factors influencing success — contractual structure, past experience with value-based care, market stability, practice culture and leadership effectiveness, for example. Motivating the elephant is not just about communicating the potential and/or aggregate upside of value-based care, but, rather, communicating with relentless clarity what the individual clinician needs to do each day, with each patient encounter, to contribute to building and capturing those benefits. Value-based care payment and compensation models need to be simple and transparent — complexity creates confusion and confusion is molasses in the gears of change.
In closing, I would argue that many practices have enough infrastructure in place today to be successful in the early phases of value-based care. There remains tremendous variation in how we currently practice — and as practices consolidate, that variation is predominantly within practices rather than between practices. Our greatest asset lies within our peer relationships and the recognition of our interdependence and commitment to collective success. Rather than overhaul our infrastructure, we can be lean and successful by identifying and prioritizing the biggest opportunities and then learning from those doing it well today. We can build a cultural and organizational foundation for success by identifying and emboldening those high performers to illustrate and lead successful change.
- Reference:
- Heath C, et al. Switch: How to change things when change is hard. Penguin Random House; 2010.
Richard C. Mather III, MD, MBA, is chief medical officer for Optum Specialty Care and clinical associate professor in the department of orthopedics at Duke University School of Medicine in Durham, North Carolina.
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