5 ways to align value-based care models

Amid a dizzying array of value-based care models, health systems often struggle to balance the requirements of value-based care with the complexities of care management. These challenges only multiply if organizations participate in multiple value-based care models managed by multiple entities. A recent paper in the Journal of the American Medical Association Health Forum sheds some light on how to reframe care management as a truly patient-centered process. 

The Centers for Medicare & Medicaid Services currently lists 33 new payment and service delivery models that are active, announced, or authorized for expansion. State-level models for Medicaid beneficiaries are common, as are accountable care organizations (ACOs) sponsored by commercial and Medicare Advantage plans.  

The breadth of available value-based care models has influenced adoption. All told, about 41% of healthcare payments are tied to these types of payment models, according to the Health Care Payment Learning and Action Network. Roughly the same percentage is tied to pure fee-for-service models.  

The downside, the JAMA Health Forum paper stated, is that there’s inconsistency about the definition of “value” of care management across multiple models – especially when it comes to financial value compared to, say, the personal value of achieving a specific health outcome. Additionally, the presence of disparate value-based care models increases the risk of fragmented care (patients may have multiple case managers) and redundant care (patients with multiple chronic conditions may be enrolled in several condition-specific disease management programs). 

The authors – all affiliated with Mass General Brigham, which participates in multiple public and private ACO models – provided five recommendations for reframing care management as part of a broader value-based care strategy.  

Recognize that patients are multidimensional. Since symptoms and conditions can evolve, utilization may go up or down for extended periods of time. Clinical applications used to calculate a patient’s risk of poor health outcomes must be able to account for this fluctuation. 

Offer care management as a continuum. Identify opportunities to apply low-touch, high-tech interventions for patients with specific non-complex needs, such as managing a single chronic condition. This enables high-touch resources to apply to complex cases and provide the holistic, multidisciplinary services that are the typical backbone of care management. 

Ensure efforts are coordinated – and integrated. To avoid fragmentation, care teams should facilitate engagement among entities eligible to provide services to patients under a given value-based care model. This should include community-based organizations as well as affiliates or partners of a patient’s insurance provider. The authors caution against encouraging patients to self-navigate these services given the volume of phone calls, faxes, or emails that may be required to obtain referrals.  

Commit to ongoing evaluation of effectiveness. Assessing utilization and cost of care is important, but those shouldn’t be the sole key performance indicators, especially as short-term increases in utilization (for, say, preventive care) can lead to long-term benefits. Here, gathering patient-reported outcomes and patient experience data can help inform the value of care management. In addition, consider short cycles of testing and evaluating services to allow for more adaptive and responsive program design. 

Reframe value to consider equity and patient-centricity. Health systems leaders need to understand that care management programs targeting underserved and vulnerable populations will need a longer onramp for achieving ROI. Not only will new patients utilize more services, but clinical teams will need to build relationships with them. In fact, “value” may need to be reframed entirely to encompass its impact on equity and outcomes – and not just the bottom line.

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.