The Road to Value-Based Care: Key Takeaways from Navina’s Panel Discussion at Reimagining Primary Care 2024
The shift towards value-based care is one of the most important developments in healthcare. It has the potential to transform the ways patients experience care, the ability of clinicians to positively impact patients’ health, and much more. But the transition to value-based models can be challenging, requiring creativity, innovation, and a full-team effort on the part of healthcare providers.
To shed light on how to successfully manage that transition, today and in the future, Navina recently sponsored a panel discussion at Reimagining Primary Care 2024 in Boston. The multifaceted perspectives we heard there gave us a chance to learn from physicians and healthcare experts with significant value-based experience. Over the course of a 45-minute discussion moderated by our own Vice President of Value-Based Care, Dana McCalley, panelists shared some of the most important lessons gleaned from their rich professional experience.
Keep reading for some highlights from the session.
The road towards value-based care isn’t always smooth, but positive patient experiences make a powerful difference
While value-based care continues to expand, it is still far from becoming the dominant model in the U.S. – and some of the programs that are available are not as transformative as some might imagine. As Dr. Lara Terry, Chief of Value-Based Care at Boston Medical Center, put it, “the vast majority of value-based care models are still really a fee-for-service chassis with a shared savings component.”
As value-based care becomes more prominent in the U.S., a common challenge is dealing with hesitation among patients. “From the patient perspective, there's a lot of concern about what being on managed-care contracts means,” said Dr. Ashley Chou, Senior Medical Director and Vice President of Medical Management at Oak Street Health. “And a lot of patients got burned by the HMOs of the ‘80s and have this skepticism about [working with] a managed-care provider.”
Luckily, gaining experience with value-based care often changes patients’ perspectives and increases their level of engagement with their healthcare. “I spend a lot of time in the clinics with the clinicians. I see patients, I hear their stories, I read their comments,” said Dr. Erica Savage-Jeter, Division Chief Medical Officer of Expansion at CenterWell Senior Primary Care. “They experience our care model as it relates to value-based care and they see the differentiation. They know how we manage them is different from what they've experienced in their other physician groups or provider groups. And that's what gives me hope, because it takes an engaged patient to really improve that patient’s outcomes.”
The challenge isn’t just adopting value-based care, but making it coexist with fee-for-service models
Much of what makes the value-based journey so difficult is not the value-based model per se, but rather the need to allow for both value-based and fee-for-service models to coexist within the same organizations and systems.
Dr. Terry said that after years of intermittent progress towards value-based care, much of the healthcare world is now dealing with both value-based and fee-for-service models. While this represents progress, the need to simultaneously navigate both approaches to healthcare can be difficult and labor-intensive.
“You're in neither world. So in essence, you're doing twice the work because you're trying to sustain this fee-for-service, RVU-driven system,” she explained. “And at the same time, you've added this additional accountability for quality and outcomes, so you're really rocking back and forth. I think that's driving a lot of what we're seeing in terms of burnout and providers kind of feeling overwhelmed.”
Part of the challenge stems from the mismatch between fee-for-service and value-based mindsets among medical professionals, given the fundamental differences between the two models. Dealing with both payment models simultaneously also entails a lot of logistics and administrative work. Even within the world of value-based care, relying simultaneously on a variety of contracts with significant differences can add to the logistical challenges.
There are concrete steps that healthcare organizations can – and should – take to support the transition towards value-based care
One key step to easing the value-based transition is training physicians with a fee-for-service background, giving them the knowledge they need to thrive in the value-based environment and making sure they see the value-based care model as beneficial to them.
Given the challenges that often result from an overabundance of unstructured patient data and the need for accurate and thorough HCC coding, our discussion also touched on the usefulness of artificial intelligence (AI) in terms of managing information, emphasizing the need for solutions that can turn massive amounts of fragmented data into actionable insights at the point of care. AI-driven tools can also help identify gaps in care and actionable plans for patients, particularly those with complex health needs. This not only improves patient outcomes but also helps in managing the cost of care and alleviating some of the key challenges associated with value-based care.
A shared workplace culture of value-based care can also have a powerful impact throughout the organization. “Getting the culture right is imperative to do this work. This work is hard; primary care is hard. And it is so challenging if you're coming to work every day [feeling] miserable,” explained Dr. Chou. “You have to have a relentless determination to get things right, to partner with people across the aisle, and to learn from each other – to support each other – all for the best interests of the patient.”
Another compelling idea that our panelists discussed was cooperation across medical organizations. “One of the unique things that we're doing in the state of California is that we have a voluntary, multiplayer primary care initiative where Blue Shield and four of our competitors have come together through a third party,” said Laura Fox, Director of Payment Innovation at Blue Shield of California. “We're saying, ‘Look, we compete on all sorts of things, but on primary care, what happens if we all come together and try and have one payment model, one attribution, one core set of six measures, and one platform that we're going to share the data on?’”
Finally, the discussion explored ways to prepare tomorrow’s value-based care physicians and other professionals. “We love to collaborate and get involved with medical schools and residencies,” said Dr. Savage-Jeter. “We want to show that there are other payment models besides direct access and fee-for-service, and that there's a whole other model of care that has been designed around this payment model. So we want to interact with the students and the residents and show them this payment model as well, and create that pipeline.”
For a deeper dive into our panel discussion at Reimagining Primary Care 2024, click here to watch the full event on demand.
