The Executive Suite: Value-based incentives improve clinical connectivity

The past year has been very hard on independent practices as patients took the necessary steps to reduce risk and stay home. As we begin to return to pre-pandemic patient volumes and rebuild our businesses, we are increasingly seeing employers adapting to a post-pandemic world by looking for new, transformational innovations to add to benefit plans that will improve the value of healthcare investments for themselves and their employees.

These two forces have presented an opportunity for independent physician groups that cannot be ignored. Transitioning to value-based reimbursement models will enable alignment with employers around shared goals of reducing costs and improving outcomes.

Seeking opportunities to create value

In Texas, the cost of family health plans has increased an average of 4% every year since 2010, according to research from The Commonwealth Fund. In the Dallas-Fort Worth area, two primary health systems have subsumed most of the area’s physician groups, leaving employers —approximately 75% of which are self-insured—and their workers locked within the confines of an inefficient healthcare system. Compounding the problem is the fact that Texas has one of the nation’s largest uninsured populations. Even though we can see the light at the end of the tunnel of our current healthcare crisis, other challenges persist. Practices can—and must—take charge in tackling these challenges.

Reinforcing care coordination with Episodes of Care (EOC)

The concept behind an EOC model is fairly straightforward: A single, pre-determined bundled price is guaranteed to the payer for treating a specific illness, condition or medical event and that price includes all services associated with the treatment over a fixed period of time—regardless of whether those services were planned or unplanned. Through this model, high-performing networks coordinate care and share accountability for delivering the care within the total bundled price while also achieving mandatory quality metrics, thereby aligning incentives around a common goal.

Since payment for care is aligned with positive patient outcomes, the practice of care becomes more holistic and focused on prevention. Avoidable adverse events are reduced, expensive and unnecessary tests can be avoided, and sites of service can be selected strategically. The real winners will be the patients, whose portfolio of varied physician specialists can now function more as a single, clinically connected team. This allows patients to efficiently leverage a wide range of medical expertise, which will enhance the quality of care, and ultimately lower the overall costs.

Independent physician practices considering value-based payment models should consider a risk-bearing partner with the expertise and technology to help them make informed decisions about the quality and cost of their treatment options for patients they are treating within an episode.

Leading the way

I firmly believe that our transition to EOC positions us at the leading edge of healthcare delivery, all while strengthening clinical and financial outcomes through better alignment between physician, patient, and payer. Because our episodes-based programs address a substantial portion of the average employer-sponsored health plan’s costs, we are empowered to engage self-funded employer organizations directly with a significant value proposition of lower-cost, higher-quality, better-coordinated care.