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Top 5 Challenges in Value-Based Care (and How to Solve Them)

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Morgan Watson
November 9, 2022

Healthcare is undergoing a transformation and value-based care is taking center stage. American physicians are increasingly participating, with 54% of them reporting being in at least one accountable care organization. This figure jumped 10% from 2018 to 2020, according to the American Medical Association during their Physician Practice Benchmark Survey.

Although participation is increasing, common challenges still threaten to steal the show. Previously we’ve discussed the challenges of healthcare interoperability, but now we are taking a deeper dive into 5 major challenges within value-based care.

What is Value-Based Care and Why Does it Matter?

Over the past 14 years, the federal government has passed regulations that have pushed providers toward value-based care over fee-for-service. According to the Centers for Medicare & Medicaid Services (CMS), by 2030, all traditional Medicare beneficiaries will be treated by a provider that participates in a value-based care model.

The value-based care model differs from the traditional fee-for-service model because it compensates providers based on the quality of care provided rather than the number of medical services provided. With a shift in focus from quantity to quality, patients will receive better care at lower costs.

Challenges in Value-Based Care

Challenge #1: Keeping Up With the Latest Trends in Value-Based Care

The healthcare industry changes at a rapid pace. New trends in value-based care are constantly being developed, tested, and implemented by CMS. It can be difficult to stay ahead of the game, especially if you're just entering the value-based care space.

Solution: Educate yourself. It is so important to become more educated and learn the ins and outs of new topics that come to light in value-based care. Fortunately, there’s a resource that does the work for you. The VBC Exhibit Hall curates extensive coverage with a free email newsletter weekly and a resource center library.

Challenge #2: Social Determinants of Health

Social determinants of health (SDoH) are factors that influence a person's ability to lead a healthy lifestyle. These include things like poverty, education level, access to healthcare, housing conditions, and food security.

Here are a few examples of how SDoH can affect an individual’s physical health: 

  • Poor nutrition caused by food deserts can lead to obesity
  • Low-income households cannot afford basic needs such as food or healthcare resulting in malnutrition, untreated infections, diseases, etc. 
  • Poor mental health can make it difficult for patients with chronic conditions to control their symptoms 
  • Individuals who lack formal education are less likely to seek out preventative care 
  • Individuals who are not fluent in English struggle to communicate their health issues and may not receive adequate care

Solution: SDoH screening or analytics vendors. SDoH can be identified and addressed easily with the right patient research or analytics vendor. 

The Accountable Health Communities Health-Related Social Needs Screening Tool is a self-administered test created by CMS that providers can use to better understand SDoH that may be affecting their patients.

Spatially Health is another great resource that providers can use to determine SDoH. It’s an analytics platform that uses data to locate individuals that need assistance due to SDoH, then helps align them with the proper services and providers.

Challenge #3: Generating Patient Engagement

Patient engagement is essential in value-based care since the results of patient engagement align directly with the goals of value-based care. If providers can effectively empower patients to participate in their healthcare routines, they can improve the quality of care, increase patient satisfaction, and reduce costs. 

Patients want to be able to manage their own care, understand the costs involved in their treatment, and make better decisions about their healthcare.

Solution: Digital patient engagement tools. Patients can use these tools to manage and make informed decisions about the quality and cost of their care. By comparing different options in terms of price, quality, convenience, etc., they ensure patients are getting the best healthcare experience possible. 

Here are a few different types of digital tools that providers can use to increase patient engagement:

  • Telehealth services, specifically for behavioral and mental health 
  • A website where patients can easily self-schedule in-person appointments 
  • An automated messaging service that delivers test results, appointment reminders, etc.
  • An app that helps patients compare different treatment types 
  • A web-based tool that allows patients to track medical expenses
  • An online platform where patients can submit claims

Elaborate is a digital patient engagement tool that integrates seamlessly with your EHR system and allows patients to self-schedule televisits or in-person appointments. It also allows providers to send lab results directly to patients, explain what they mean, and advise on what they should do next. 

Bravado Health aims to improve healthcare through digital patient engagement by closing the communication gap between healthcare providers and their patients. The company’s unique platform can help providers reach out to patients with tailored care plans, outside the walls of healthcare facilities, based on existing EHR data, resulting in better care. 

Rivet helps providers become more profitable through patient engagement. Through its powerful revenue cycle management software, Rivet allows providers to send healthcare expense information directly to patients via cell phone or email. Then, they receive various payment options that allow for a more flexible transaction process.

Challenge #4: Analyzing Data for CMS Audits and Incentive Payments

To judge the eligibility of a clinic for the Merit-based Incentive Payment System (MIPS), CMS completes an annual audit. Analyzing the data for these audits is extremely valuable, but it tends to be labor-intensive, and many healthcare organizations lack adequate resources.

Solution: Consulting companies and data reporting services. Instead of dedicating time and money to hiring and training a team to analyze data, you can partner with experts who make the work look effortless. 

When looking for a value-based care consultant consider consultants like Chirpy Bird. Chirpy Bird is a woman-owned health IT consulting company that helps physicians and groups across the nation with strategies for quality programs, HIPAA audits, and more.

Healthmonix is another unique company that uses data reporting to improve healthcare. They pull data from spreadsheets, EHRs, claims systems, EMRs, and other systems that lack easy-to-use interfaces to remove the burden from providers who participate in MIPS, an APM. etc.

Challenge #5: Collecting Data From Disparate EHR Systems

Collecting accurate data proves to be one of the most significant challenges in value-based care, and it’s especially difficult when you have multiple providers using different platforms.

The best way for healthcare professionals to collect patient data is through electronic health records (EHRs). There are many different types of EHRs, and each one has its challenges when it comes to collecting, analyzing, and sharing patient data across multiple institutions.

Solution: An interoperability strategy. Regardless of your situation, data plays a crucial role in value-based care. There are several methods of getting the data, and Brendan Keeler wrote a wonderful guide to choosing the best ones for you called How to Win Friends and Integrate Systems.

Your company probably has a few integrations in place (or attempted to do so), and you've seen first-hand the work and costs involved. Partnering with a standards-based platform may be more appropriate if you need support for just a few EHR systems. Healthjump might be a better choice for you if you need interoperability with a large number of EHRs and want it fast.

Contact our team of data experts and see how you can scale your business by getting health data consistent and fast.

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