For more than a decade, there has been a gradual shift from fee-for-service to value-based care. As annual healthcare spending eclipses $3.5 trillion in the United States, value-based care initiatives are viewed as an opportunity to slow rising healthcare costs while also narrowing the gap between cost and quality. It is true that some states have moved quicker than others to adopt, but one thing is for sure: value-based care is here to stay.
Need proof? Look no further than some of the nation’s largest health insurers, including Cigna, United Healthcare and Aetna, which report paying more than half of their reimbursements to medical providers through value-based models. This means more reimbursement to neuro and orthopedic physicians is coming from bundled payments and pay-for-performance contracts than ever before. So, the question for independent neuro and orthopedic physicians is no longer, “should I adapt to value-based care?", but rather “how can I embrace value-based care?”
What is value-based care?
Value-based care is a simple concept — to reimburse providers for care based on patient outcomes instead of volume of services. This contrasts with a traditional “fee-for-service” model where providers are reimbursed separately for the services provided.
In a value-based care model, the emphasis is on quality — not quantity — of the services. It is focused on outcomes and total continuum of care which requires a higher level of collaboration between clinical partners and encourages efforts to make best practices the standard practice.
Impact on independent neuro and orthopedic physicians
So, what does this mean for independent neuro and orthopedic physicians? Fortunately, the goal — to provide the best care to patients — does not change. However, it is now incumbent upon physicians to explore ways to reach this long-standing goal while embracing value-based care concepts. Sure, this transition can seem daunting and disruptive to the independent physicians practice. Yet, with the right tools and infrastructure, there are opportunities to evolve in ways that will help independent physicians thrive in a value-based world.
Where to begin
Data analytics are a great place to start. Through the right tools and infrastructure physicians are better able to understand, analyze and leverage key performance indicators and outcomes data. A deep dive into data can tell an important story. It can highlight best practices, identify opportunities for improvement, and potentially uncover cost-savings measures. It is an opportunity to gain knowledge that can spark improvement in the practice and chart a path forward.
Through data analytics, independent neuro and orthopedic physicians can also discover trends among their patient population and use risk models to predict outcomes that may help lower readmission rates, which is a key measure in value-based care. During a time when more reimbursement is tied to patient outcomes, focusing on existing data can be essential to a stronger bottom line.
If you are interested in learning about the tools and infrastructure necessary for driving quality and efficiencies, but not sure how to get started, MPOWERHealth can help. Our trusted team of value-based experts have deep experience working with neuro and orthopedic physician practices and can provide the insights and guidance you need.