The Executive Suite: Risks of delaying your value-based care journey

Providers, health systems, and health plans across the country continue to be engaged in conversations about value-based care – and often the focus remains on the burdens and challenges of making the shift.

Across the industry, we hear about the difficulties of transitioning from fee-for-service to value-based care, and those concerns are valid. However, we also hear something else: that many organizations want to adopt new value-based care strategies, but lack buy-in from stakeholders or don’t know when it will really be worth it to start the journey.
It’s always easy to talk about the challenges associated with change, but what are the potential opportunity costs of not making the transition to value-based care?

Value-based care on the rise

It’s no secret that investment in value-based care models is increasing. According to a McKinsey & Company report, the investment in value-based care quadrupled during the pandemic.
Providers are incentivized to adopt value-based care strategies as they contain a promise of delivering higher quality care while reducing costs and increasing revenue. But, any major transition requires resources, attention, and a willingness to operate in the messy middle while moving toward fuller adoption – which is where many organizations fail.

Health care organizations face a series of interrelated challenges, which can also be viewed as correlated goals, when it comes to delivering better care that’s financially sustainable. In 2007, the Institute of Healthcare Improvement introduced the “Triple Aim” of improved patient experience, better outcomes, and lower costs. It has since evolved into a Quintuple Aim which spans patient experience, health care costs, population health, staff well-being, and health equity.

These are the pillars of value-based care models, and successful adoption requires more than just vision, it requires an organization-wide action plan and ongoing commitment.

Given these complexities, it’s easy to think of value-based care as a lofty goal, or something too big and abstract to pursue successfully. Changing the financial, clinical, and operational functions of an organization does carry risk, but there are also downsides to the status quo.

Money left on the table

Value-based care focuses on delivering efficient, high-quality health care that prioritizes patient outcomes. By not embracing this approach, health care organizations may lose the opportunity to optimize savings, enhance patient satisfaction, and increase revenue.

The number of value-based care programs available to providers continues to grow in the Medicare/Medicaid and commercial markets. Often, the key to success is aligning your organization's strengths with a program's objectives, requiring an understanding of the care model and targets as well as the data that show where your organization has the capacity and capabilities to impact program metrics.

As organizations begin to participate in more value-based care models, data and analytics need to be integrated into your care team’s workflows, offering actionable insights at the point of care and population level to identify opportunities for improved patient outcomes.

In a health care landscape where cost-effectiveness and patient satisfaction are paramount, dismissing value-based care is equivalent to bypassing an avenue for financial gain and improved patient care. Just as leaving money on the table signifies lost opportunity, not embracing value-based care means leaving financial benefits and enhanced patient well-being untapped.

You’ll have to do it eventually – on someone else’s terms

It may seem easier to think that value-based care isn’t something your organization needs to worry about now, but that would be a mistake. Value-based care isn’t going anywhere—and though financial incentives for adopting value-based care may be faster or slower depending on the U.S. Centers for Medicare & Medicaid Services, your state and other factors, the industry is moving in a new direction.

Making proactive decisions about your data management and necessary workflow adjustments makes a lot more sense than having to move when contractual pressure comes all at once. Start the journey toward value-based care on your own terms, because acceleration under pressure will create patient, operational and financial risk.

Missed care opportunities that lead to suboptimal patient outcomes

Value-based care is centered around enhancing patient outcomes and experiences. Delaying the transition may lead to missed opportunities to provide your patients with more effective, coordinated care.

Under a traditional fee-for-service model, health care providers are incentivized to deliver more services, which can lead to unnecessary treatments and fragmented care. In contrast, value-based care directly aligns provider incentives with patient health. By focusing on preventive care, care coordination, and patient engagement, health care organizations can proactively address health issues and equity, reduce hospitalizations, and ultimately improve patient well-being.

By shunning value-based care's incentives and data-driven strategies, the path to improved patient well-being becomes more challenging. Adhering to outdated models not only jeopardizes patient care, it also stalls the progression of health care as a whole.

The big picture

Regardless of the care model, everyone has the same goal: find financially sustainable ways to improve patient health. Too often, care teams don’t have the tools or resources they need to accomplish that goal.

For organizations that are ready to start the journey toward value-based care on their own terms, the right data, quality measurement, and analytics solution are critical components of future success. Though the health care industry is so large and complex that it may seem impossible to change, many individual providers can move the dial simply by getting started.

The overarching lesson here? Don’t let perfect be the enemy of good. No one expects a complete switch to value-based care overnight. If organizations have a plan to move in that direction, and start putting the infrastructure in place now, they will be well-positioned to succeed in today and tomorrow’s health care economy.