Value-Based Care: Digital and Cultural Solutions to Support Adoption
Value-Based Care: Digital and Cultural Solutions to Support Adoption
Introduction
Value-based care (VBC) is here! VBC payment models are accelerating a move away from fee-for service (FFS), elevating the role of primary care physicians and driving new incentives for integrated care delivery across healthcare disciplines.
For the last decade, value-based care has been discussed, piloted, and experimented with across the medical provider spectrum. Providers and provider organizations who work with payers on VBC programs have become increasingly popular and continue to show a decreased spend or control of the cost curve. Outside of well-demonstrated and successful primary care and internal medicine providers, a variety of specialties are working in various reimbursement and delivery models labeled value-based care. These specialties include, but are not limited to behavioral health, dermatology, dental services, cardiology, nephrology, gastroenterology, urology, intensive care, surgery, and oncology. While there are many challenges facing value-based care models and programs, value-based care is here to stay.
Oncology Care Partners is purpose-built to develop a robust value-based care program for oncologists and oncology patients and to re-engineer and overcome the challenges that oncologists face when adopting this type of care. The adoption of user-friendly digital tools, the recognition of a need to develop a patient-centric culture, and the recognition of team-based care models can help oncologists overcome these challenges and provide better care for their patients.
Summary
Barriers to Value-Based Care Adoption
There are two major points of disruption that are key to a successful value-based care delivery platform. The first is disruption to the current practice workflow culture, which requires a mindset change from the industry norm of building care teams and systems to support volume and manage throughput, to a model that supports the care team’s time and connection to the patient and to the caregiver. This mindset shift will enable clinic operations to treat, guide, heal and support the patient’s care journey.
The second point of disruption is the implementation and integration of innovative digital tools to help close gaps in data collection and interoperability and promote data exchange between care team members and patients. Gaps in interoperability can make it difficult for easy data exchange and care planning communication, which ultimately leads to inadequate patient care adherence, poor patient engagement, poor outcomes, and higher costs. The use of digital software tools can help oncologists overcome these challenges by automating tasks associated with data collection and reporting.
Setting the Right Workflow and Care Team Culture
For over 50 years, patient care provided in a physician office was centered on caring for a patient as they present with symptoms of disease or ailments. The physician’s team was predominantly a receptionist, a nurse, and a business team member (for billing). The team culture was focused around assisting the provider in moving patients out of a waiting room and into an examination room. As more of the population became insured after the implementation of Medicare in 1965, physician offices began to take on more patients daily. The physician office slowly, out of need, transformed to a more adept and efficient workflow model.
Today, cancer patients are seen in large throughput models, both in the community and in hospital owned practices. Practice physician providers see 25+, 30+ or even 40+ patients per day and utilize advanced practice providers (APPs), nurses, medical assistants, and other team members to adequately provide care to patients. This model is dependent on revenue per patients seen with workflow and business teams built to focus on successful operations. Front and back-office staffing resources, business leaders and even the real estate is designed to maximize the movement of patients from arrival to discharge.
For value-based care to succeed, it is essential to reengineer or disrupt the throughput culture. In oncology, this process must be led by the physician providers and their leadership teams. Mindset around work relative value units (wRVUs), number of patients seen, internal ancillary services utilization and revenue-driven drug formulary design must be replaced with a team care approach, patient and caregiver satisfaction, focused symptom management, service and financial navigation, and the ultimate cost of care to the patients and employers.
As an example, the modern value-based care office workflow is primarily focused on ensuring adequate time and resources for patient management, coordination, and care team and caregiver communication. Many of these tasks can be streamlined with digital tools, which can help decrease emergency room visits, decrease calls to the office for information and clarification, and promote greater adherence to a physician’s care plan.
Difficulty with Data Collections, Interoperability, and Reporting Patient Information
Today, many aspects of oncology healthcare are driven by data, from treatment decisions to reimbursement models. However, collecting and reporting data can be a challenge for oncology practices and oncologists. One reason is that cancer patients often see multiple specialists in a fractionated environment and have complex treatment regimens, which make it difficult to track all the relevant data points. For example, a patient may see a surgeon, then a medical oncologist, and then a radiation oncologist, all while having diagnostic ancillary service specialists such as radiologists or pathologists review their cases. Each of these interactions can be documented in separate medical record systems and disparate provider systems.
Additionally, some medical oncology practices are still using paper medical records, which make it time-consuming and error-prone to collect and report care data of any kind. Since true value-based care must be centered around practitioner coordination, transparent communication, and patient participation, it is essential that all members of the care team have access to the same patient information. When this information is not readily available, it can be difficult to provide coordinated care.
1. Data bottlenecks in EHR system
An easy, intuitive, and well-designed Electronic Health System (EHR) can empower higher-quality care and streamline your practice workflow. On the other hand, an EHR with a clunky interface and inefficient data sharing can quickly put a damper on productivity.
Solution: Select the Right EHR System
The right modern EHR system, along with standardized utilization and adherence to EHR usage allows oncologists to easily collect and report data points on patient history, treatment plans and outcomes, resulting in reduced administrative burden and improved patient care.
Solution: EHR-Integrated Mobile Applications
Mobile applications can be very useful for treating oncologists and their patients, as they can provide access to care information and data at any time and from anywhere. There are many different types of mobile applications available, including those that allow patients to track and report their symptoms, schedule appointments, and view their medical records. It is important for oncology practices to select digital tools that can be easily integrated into their existing electronic health record (EHR) system and practice workflow. This will allow for seamless data sharing and make it easier to track patient progress over time.
2. Poor Interoperability
Interoperability continues to be a challenge for providers. This is most often due to disparate practices, service sites and electronic health records (EHRs) that are not always integrated with other systems, such as labs and imaging. This lack of integration makes it difficult for practices and oncology care teams to get a complete picture of their patients’ health.
Solution: Integrated EHR System
The right integrated EHR system will provide real-time access to a much larger portion of patient care data. For example, EHR systems must integrate the ability for viewing laboratory results, imaging studies and pathology results directly within the EHR. This gives the care team a more complete picture of their patient’s diagnostic results and other important health information that helps guide the care team in making better-informed treatment decisions.
3. Increased paperwork, denials, and documentation requirements
Paperwork and documentation requirements, predominantly resulting from a denial or the need for an appeal, continue to increase in the world of cancer care. It seems 5-10 years ago that authorizations and approvals for cancer patients were almost automatic. Today, authorizations and approvals are strictly required for nearly all treatments: infusion drugs, supportive care drugs, lab tests, genetic tests, and common diagnostic procedures are all denied for payment without appropriate authorizations. Requests for additional information for denials are common and the time to adjudicate denials is significant. With the right digital tools in place, EHR required fields, proven evidence-based care plans and the right value-based contracts, time spent on authorizations and approvals will decrease or even be eliminated.
Solution: Pre-populated Templates in EHR System
Forced pre-populated templates and required information fields in an EHR system, combined with good value-based contracts, can help minimize time spent on authorizations and approvals. The right EHR system provides templates, required data fields, and forms that can be easily completed and accessed within the EHR system to help decrease manual denial appeal processes and outcome data. Additionally, working with experienced contract leadership can help your organization understand the nuances of advance value-based contracting and the requirements for documentation, pre-authorizations, referrals, and denials.
4. Inadequate Patient Engagement
Another challenge that oncology care teams face is engaging patients and caregivers in the participation of their care. This is important because true value-based care relies on patients and their caregivers taking an active role in managing their health. When patients are not engaged or lack information on their care, it can lead to poorer outcomes and higher costs.
Solution: EHR-Based Patient Portals & Advanced Digital Connection Tools
Easy to use patient portals and advanced digital tools can be used to support value-based care, manage patient navigation, and provide patients 24/7 access to their medical care team. Additionally, portals and oncology-specific digital tools can provide formats for educational resources, reporting of symptoms and appointment scheduling capabilities.
Solution: Remote Monitoring Tools
Remote monitoring tools are becoming more common as oncologists look for ways to provide care for their patients from afar. These tools are a must have for the provision of true value-based care and allow for a patient’s vital signs, medication usage, pain levels and other important health data to be monitored by the care team. This type of information can be very helpful in managing a patient’s care during active treatment and ensuring proper navigation, follow-up, and care plan drug adherence.
Solution: Direct Texting
Direct texting with patients is a newer technology that is becoming increasingly popular. This type of tool allows oncologists to communicate directly with their patients, without having to go through a third-party provider. This can be very helpful for coordinating care and sharing important information.
5. Lack of Data to Support Decision Making
In a value-based care model, oncologists and their care teams are accountable for the quality of care that they provide. This means that they need to have data to support the decisions that they make. Big data and predictive analytics have an immense role to play in value-based care.
Solution: Web-Based Tools for Patient – Reported Outcomes (PROs)
PROs are now commonly used in value-based reimbursement arrangements and can be a helpful tool for oncologists. PRO data helps assess the patient’s quality of life, which is an important metric in oncology care. There are many different digital software tools available to support PROs, including web-based and mobile versions.
Solution: Data Analytics Platforms
Data analytics platform issues can help be achieved by use of digital software tools developed specifically for oncologists to collect and track important data. These data can then be used to generate reports that can be shared with the patient’s care team. These reports help to identify areas of improvement and make sure that the patient is receiving the best possible care.
Next Up: Alignment of Incentives
Alignment of incentives is critical to the success of any value-based care model. The traditional fee-for-service model has created a system where providers are paid for the volume of services that they provide, rather than the quality of care. This needs to change for value-based care to be successful. Our next article will focus on alignment of incentives away from buy-and-bill and discuss some of the challenges and solutions involved.
How Oncology Care Partners Can Help You
Oncology Care Partners brings the capital, operating expertise to initiate and operate essential digital software tools, and the right workflow pathways to help facilitate change in culture in any value-based setting. OCP’s model of focusing only on value-based care patients in a value-based care setting enables the appropriate digital tools to be aligned with the needs of patients and payers.
OCP’s experience and current relationships with payers and at-risk MSO and ACO’s can provide oncology practices and independent oncologists with significant benefit in working with and managing successfully in a true value-based world!
Contact us today if you would like more information about our value-based oncology program offerings or if you want to learn how we can help you meet value-based care measures.
Contact Erich Mounce or Joe Pietrzak at [email protected]
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