Value Based Care will fail without systemic changes to execution

Authors: Jeffrey Springer, SVP, Product Management & Purva Shelke, Product Analyst, Perform+

Value-based care can’t function without strategic, strong, and effective partnerships. Recent events like recommendations for CMS to consolidate value-based payment models (VPM), CMS’ call for a Universal Foundation of quality measures, and the launch of ACO REACH as a health equity-focused VBP, require tighter and more effective relationships.

When strategically and operationally aligned, all value-based care stakeholders – payers, providers, patient-members, public health, and social-community service organizations – can find synergies in what makes them individually excellent. Then, they can leverage data and technology to create or evolve value-based care models to positively impact health outcomes, care quality, and cost efficiency.


Strong, synergistic partnerships

When one or more healthcare organizations partner with or seek out other partners that they will need to create or implement their VBC program, it’s critical to assess and understand stakeholder roles, objectives, processes, and pressures. How does this program and opportunity fit or elevate existing strategic initiatives and investments?

2022 survey by the Healthcare Financial Management Association (HFMA) found that 50% of health system chief financial officers and other executives say that strategic partnerships with payers are their top external challenge.

Effective collaboration and cooperation can emerge from leadership and team assessments and group exploratory strategy sessions. Building trust among stakeholders will help dispel misconceptions and bring transparency around others’ intentions, commitment, and shared authority and responsibility.

For example, health plans may want to mitigate risks and costs associated with unplanned, delayed, or unnecessary care. They’re looking to optimize network access while taking a more population-based approach to products and offerings. They are keepers of claims data, risk and severity information, and quality information across providers.

On the other hand, providers may have achieved a long-lasting presence in their community with a growing team of employed clinicians. They are keepers of clinical data, research work, evidence-based care, and pathways, as well as quality metrics. They’re looking to seamlessly provide their patients with the best, most cost-effective, and evidence-based care.

The same HFMA survey quotes a participant, saying, "The one-size-fits-all, 'I-win-you-lose' approach is no longer a good business model."

Exploring common strengths, revealing areas where each partner can support the other, and what each partner brings to the VBC program that others don’t form a solid foundation for success.


Shared care quality, performance, and aligned financial goals

VBP analysis published in 2021 by MedPac (the Medicare Payment Advisory Commission) found that a handful of value-based programs yielded positive care, quality, and financial improvements, including:

  • Medicare Shared Savings Program (MSSP)
  • ACO Investment Model (AIM)
  • Pioneer ACO model
  • Physician Group Practice Demonstration
  • Comprehensive Care for Joint Replacement Model for hip and knee replacements

Key to successful VBC partnerships is leveraging models, waivers, or funding grants with the most promise and that offer the best motivation, structure, and requirements that meet stakeholder strengths.

Other research by HFMA found that several value-based and population health-related areas where partnering shows the most promise for achieving mutual goals:

How do each stakeholder’s population profiles, quality performance history, as well as financial, operational, and technical prowess contribute to the success of a joint VBC program?


Operational alignment, coordination, and cross-organizational education

Successful value-based care programs are vital in operational capabilities, communication, and engaging people internally and externally.

How will the partner organizations work collaboratively and overcome the most common challenges in VBC:

  • Attracting program candidates
  • Qualifying prospective candidates
  • Streamlined enrollment and adequate onboarding
  • Identifying high-priority needs or gaps in care
  • Effective referrals for services from partner organizations
  • Coordinating data, documents, and activities using technology
  • Education inside and outside the program to ensure all program staff can manage their part of the referral workflow
  • Follow-up communication and referral follow-through

Coordination across organizations, self-service identification by providers and patients, process-driven data sharing to close care gaps, and ensuring tight program oversight are all stepping stones to achieving positive value-based care outcomes.


Data, analytics, and technical tools

Each stakeholder has existing processes, data sources, software, and technologies. Vital to VBC partnership success is assessing and aligning capabilities, capacity, and resources.

Together, partners are creating a temporary ecosystem while the program is in place. Systems, data, reports, and the technologies that automate and connect them must meet the need for program governance and management, as well as to carry out everyday operations. Additionally, all stakeholders must measure progress against program goals, report on cost, and submit required documentation to funding or governmental sources. Depending on each stakeholder's IT and technical strengths, the team can leverage interoperability, automation, data analysis, social risk scores, and software systems to give the program the best chance at effective, efficient, data-driven, patient-centric care.


CitiusTech supports value-based care models through technology, healthcare expertise, and data analytics

Our internal team of data scientists, healthcare experts, value-based care consultants, and technologists can support a multi-organization collaboration under alternative payment models. Learn more about our track record of supporting healthcare to improve care quality, control cost, leverage modern technologies, and create better consumer experiences.

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