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What does it mean to shift to a value-based model? Where does a medical practice even begin in its decision-making?
Jennifer Ternay, MBA, CPA, PCMH-CCE, founder of Values Based Care and president of JLS Advisory Group, recently joined MGMA senior editor Craig Wiberg, MLS, MBA, to discuss her new book, Roadmaps to Value-based Profitability: A Practice Transformation Guide. The book examines how practices can make the shift to value-based payment models and the steps it takes to do so successfully.
The Time is Now
While the healthcare industry has been slowly shifting to value-based care since the inception of The Affordable Care Act, Ternay stated that practices who are slow to adopt, will suffer the consequences. If providers do not start participating in value-based care, according to Ternay, they may be left behind because a variety of different avenues are being explored regarding contracts for payers. For example, "Medicaid and Medicare payers are required to actually demonstrate a certain dollar amount of care cost being covered by programs that are tied to value and quality."
The Triple Aim
There are three aspects that Ternay believes make for successful value-based profitability: improving clinical outcomes, improving the patient experience and lowering overall cost.
When shifting to a value-based payment model, Ternay stated that practices need to change their perspective. Although they may feel that they are patient-centered already,it's important to wipe the slate clean and “rethink this from a patient perspective.” How does this get done? According to Ternay, it begins with educating and empowering patients and moving away from sick care, to looking at prevention.
The Journey to Value-based Care
While the triple aim is the goal, there remains the pathway to getting there. Ternay said a good starting point is “understanding the strengths of your organization and maybe where there are some weaknesses, and putting that in context of what’s going on external to your organization.”
Next, it’s important to simplify the path and “start with an assessment, understand where you are.” If the results of this assessment are too overwhelming, remember to take a step back and take another look at your strengths so you know you have a foundation to make this change stick. Ternay said no matter the specific direction a practice takes to achieve its goals, it’s important to remember, while moving down the roadmap “to keep it simple.”
Leadership
There’s another factor not traditionally lumped in with the triple aim of healthcare—leadership. “Leadership is absolutely critical in this process,” Ternay said. Leaders need to pay attention to “what needs to change from processes and infrastructure within moving to value-based profitability.” And the leadership comes from the entire practice. As Ternay said, there needs to be “administrative leadership as well as physician leadership.”
Although the line between the administrative and clinical sides are becoming more blurred,” Ternay said they can work together to support the greater goals of the team. “Developing that type of mentality in culture is really going to be even more important as we move towards engaging patients, and addressing the issues with staff retention and even recruiting staff.”
Financial Profitability
Ternay said that “most of the payers are offering incentives that are upside only, so the risk that you run from the financial profitability piece is that you’re going to spend some resources to maybe change work processes, or roles and responsibilities, or maybe putting in technology.” So, although there is some risk, “that’s much less than when you get into a situation where you actually have risk associated with the clinical outcomes.”
Additional Resources:
Ternay’s MGMA book Roadmaps to Value-based Profitability is now available for purchase.
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