Healthcare Transformation Toward Value-Based Care: Is Value-Based Care Marketable and If So – To Whom?
Healthcare organizations are interested in value-based care’s promise for increased quality and decreased cost. But so much of what you read and experience about value-based care creates more confusion than clarity by pointing out the shortcomings of the current healthcare system that stand in its way.
That said, the progression to value-based care is happening and a recent article in NEJM Catalyst pointed to multiple pioneers in value-based programs including Intermountain Healthcare Group, Mayo Clinic and Boston’s Brigham and Women’s Hospital. Engagement is at the center of these success stories – integration and collaboration driven by a shared sense of success and accomplishment in producing a better health outcome.
Value-Based Care Stories with Real and Measurable Results
Mayo Clinic in Rochester, Minnesota, eliminated repeat lumpectomy in 96% of its patients and reduced its 30-day reoperation rate to 3.6% compared to 13.2% nationally. How? Surgeons and pathologists collaborated to analyze frozen tissue while patients were on the operating table, allowing all evidence of cancer to be removed.
Intermountain Healthcare Group requires mental and behavioral health screenings for all primary care patients and provides the needed follow-up. As a result, they reduced insurance costs for Intermountain’s own plan by $115 per member annually while improving outcomes to any primary care patient at Intermountain and passing along savings to their respective insurers.
Brigham and Women’s Hospital may require an additional step for physicians in applying the American College of Radiology’s (ACR) clinical practice guidelines but has lowered by 17% the rate of new diagnostic imaging for patients whose images are imported from other hospitals. The system improves patient safety and outcomes and reduces low-value tests, in some categories by 20%.
Overcoming the Challenges to Value-Based Care
InterMountain, Mayo and Brigham and Women’s illustrate that when value-based care is done right, the winners are patients, their providers as well as payers. The professional collaborations at these organizations seem the perfect antidote to what has been identified as the number one challenge to transitioning to value-based care: clinician buy-in and engagement. It topped the list of causes reported in a 2014 McKesson study on the state of transition from volume to value-based care.
The study surveyed 114 payers and 350 provider organizations representing a wide range of sizes and regions nationally. It predicted in 2014 and again in 2016 that value-based reimbursement will eclipse fee-for-service as soon as 2020. It also showed that both payers and providers agree on the initiatives needed for making the transition: care coordination, standardizing clinical measures, integrating work flows and patient member engagement. Despite this alignment, providers reported that they’re not meeting their value-based care goals 60% to 78% of the time. And only 41% of providers saw themselves profiting from value-based care versus 61% of payers.
Is Marketing of Value-Based Care Needed for Change Management?
So back to the original intent on writing a piece that explored whether value-based care is marketable — and to whom. The priority for marketing value-based care is healthcare professionals. It’s a call for change management and the engagement of heart and mind that is achieved through such efforts that is needed now. Value-based care is going to be the new normal and dollars will increasingly flow through value-based models. The transformation of professionals, systems and technology that must happen before it can take off is a challenge that preempts all others in this race to bring healthcare costs and quality in line.
So while payers and providers work to overcome key obstacles to implementing value- based models such as a lack of standards, analytical tools and the need for better business IT infrastructure as well as the systems to support them, they need to turn their attention to another essential tool, one that will address transformation among professionals who will bring all this change to life and sustain it. Change management communications done right is the solution. More than efforts to create buy-in, these communications efforts anchor transformation, embed purpose, establish value, support leaders and managers to communicate and build a new belief system, skillsets and relationships.
The McKesson data underscores the importance of operating environment for payers and providers on their path to value-based care. Those in collaborative, provider-centric, or payer-centric regions were further along the continuum to full value-based care than those in fragmented regions where there is little or no collaboration. Communication can give these collaborative efforts the best chance of succeeding. And in an industry where change is constant and expected for years to come, communications should be valued for its agility and the reassurance it provides.