The COVID-19 pandemic has brought about many changes within the healthcare system. Most prominently, it has exposed the downfalls of the outdated fee-for-service healthcare model.
This has prompted a renewed interest, and opportunity to fully invest, in value-based care. According to a September 2021 insights report from Xtelligent Healthcare Media, “nearly half of healthcare leaders said the pandemic would “propel the industry away from fee-for-service.”
Here are four emerging trends in value-based care to keep an eye on.
COVID-19 has forever changed the way consumers seek and access quality healthcare.
Surges throughout the pandemic unveiled the risks of fee-for-service models as consumers seek out care less – severely limiting the quantity of patients providers are able to see and be incentivized for. What has resulted is a shocking under-utilization of providers, and therefore little margin for profit for health systems.
We expect to see more providers and health systems fully immerse their practice in value-based care goals – allowing for profit and efficient utilization management overall.
One of the most prominent challenges health systems face during a crisis like the COVID-19 pandemic is to maintain adequate staffing. Here are ways you can tackle staffing challenges and avoid physician burnout.
Innovation and Accessibility of Care
In past years, we saw health systems and providers lean into telehealth. This allows for quality in-home care, which during the pandemic went from a lucrative and profitable strategy to a necessary alternative to admission at a hospital.
In alignment with value-based care goals and incentives, patients have access to telehealth services because it is the most appropriate care for their situation, not because it is more profitable.
The Centers for Medicare and Medicaid Services (CMS) further solidified the availability and longevity of telehealth by taking action to keep Public Health Emergency policies and programs in place through the 2023 calendar year. We can hope to see permanent measures put in place in the coming years, ensuring accessibility for those who are now able to receive high-quality care, as well as profitability for provider offices who have invested in telehealth technology as an enduring care delivery method.
Drastic changes to healthcare delivery, spurred by the pandemic, have created new programs, and therefore new opportunities, for providers and health systems to fully invest in value-based care goals and incentives.
In 2021, the CMS initiated new guidelines under the Stark Law and Anti-Kickback Statute (AKS) that allow more flexibility for value-based compensation arrangements. Read more about how this impacts provider reimbursement.
During the pandemic, the focus on care delivery has shifted from quantity to quality. Now is the time for health systems to follow suit to ultimately create better patient outcomes and maximize profitability.
Emphasis on Social Determinants
The pandemic has made it clear that public health and social circumstances must be taken into consideration when delivering and planning care. Within a value-based care model, providers and payors recognize the role that these non-medical factors play in patient health.
Dr. Tovar, HNI Healthcare’s Chief Medical Officer, says that “health care continues outside the hospital. Understanding the social circumstances of a patient allows the physician and health system to reduce cost both inside and outside the hospital.”
Physicians need to take factors such as transportation, food, housing, language services, and family support systems into consideration when planning care to be able to create the best possible outcome and financial cost for their patients. Being able to holistically consider and care for an individual deters additional ailments and incentivizes health systems under these new policies and programs.
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