Incentivizing physicians to focus on providing quality care to patients that enhances outcomes is what value-based care (VBC) is all about. It’s a shift away from volume-based fee-for-service care toward a new horizon in medical practice that benefits patients and providers. But there are often barriers to adopting this care model. We’ll look at some common barriers to implementing VBC and how agilon health can help to overcome them.
Examining the Challenges of Value-Based Care
Barrier 1: Data Collection, Integration, and Interoperability
So much of today’s health care is driven by data, but when organizations have difficulty collecting and reporting patient information, integrating that data to coordinate care and provide the best treatment options—including preventive medicine—becomes extremely challenging.
Because of the sheer volume of data collected, health care providers have struggled with how to record, access, and share that data effectively. Efficient data collection, integration and interoperability are key to a successful transition to VBC. How can providers overcome the inefficiencies inherent in most systems in order to leverage the benefits of VBC?
Physicians who partner with agilon health find that data collection and analysis become easier because of the agilon platform, which collects, extracts and shares financial, clinical, and social determinants data. Our cloud-based data and AI platform features a user-optimized platform that makes it easier to access this data and medical recommendations to support better outcomes and lower costs. It also meets the business needs of physician practices, integrating with EMR and payor platforms for a more efficient workflow. That means a reduction in redundancy, administrative time, and roadblocks to patient care.
Barrier 2: Changing Policies and Programs
Navigating the evolving value-based incentive programs introduced by the Centers for Medicare and Medicaid Services has proved challenging to physicians trying to shift from a fee-for-service (FFS) model to VBC. Since 2012, when the program went mainstream, regulations and policies have continuously been introduced and revised, fostering an atmosphere of uncertainty. How can physicians ensure their VBC practice complies with legal requirements when those requirements change frequently?
agilon’s commitment to governance means it is leading the way in influencing how VBC policies are developed and providing physicians the tools they need to be in compliance with federal and state laws.
Barrier 3: Unpredictable Revenue Streams and Financial Risk
Simply put, VBC is focused on moving the financial risk of providing care away from payors and toward providers, rewarding them for reducing healthcare costs and improving outcomes. At a first glance, that seems risky. Saying physicians will be compensated for quality care and actually making that work are two different things. Physician compensation is just as important to the practitioner as it is to the practice, so making the leap to a new care model can cause apprehension about shared risk or financial penalties.
Physicians who partner with agilon health benefit from a full-risk capitation total-care model. agilon contracts with insurers in each region it serves, making agilon the primary risk-taking entity responsible for the care that its physician networks provide to Medicare Advantage patients. That means physicians can count on a stable monthly payment based on the expected care patients will receive.
Barrier 4: Insufficient Resources and Inefficient Workflows
A lack of internal resources and inefficient workflows has also been cited as a barrier to adopting VBC. Overburdened staff, administrative problems, and inefficient technology all hinder collaboration in patient care and make it difficult to switch to VBC.
Partnering with agilon health increases available resources, as the agilon platform seamlessly integrates payor data, EMR data, labs, pharmacies, and other third-party outlets. That streamlines internal processes and saves staff time. The platform enables physicians to manage patient health holistically and collaboratively through EMR data integration and clinical playbooks. It also supports more efficient workflow with tools for patient engagement and easier practice management with performance management/analysis technology.
Barrier 5: Difficulty Getting Buy-In
If a practice wants to adopt VBC, buy-in from all relevant stakeholders is a must. While this might seem relatively easy for a smaller practice, larger health organizations could find it much more difficult, as numerous leaders need to sign off on changes to payment and care models.
Switching from volume-based care to value-based care is no small feat, but the benefits to patients, plus cost savings and improved operational efficiency, make the move ultimately worthwhile. Physician practices don’t need to go it alone. agilon health partners with practices to eliminate the obstacles toward a change to VBC. From our expertise and capital to our unified platform and processes, we deliver the support physicians need to make VBC work for them and their patients.
Barrier 6: Fragmented Care Delivery
Fragmented care can occur when health care providers or organizations don’t work well together. This lack of cooperation can result in a lack of care continuity that can be detrimental to a patient’s health and drive up costs.
VBC emphasizes cooperation and the team approach where all providers work together to achieve the best outcomes. To address fragmentation, agilon built its platform to be a knowledge-sharing resource. Physicians can use it to connect with other physicians providing timely information exchanges that increase care integration and better outcomes for patients.
Overcoming Challenges of Adopting Value-Based Care
To practice VBC, physicians need support. That means technology that streamlines workflow, enhances interoperability, supports collaboration between physicians and payors, and allows a practice to identify untapped opportunities for improved outcomes. It also requires contract support that allows physicians to take on the risk of the VBC model and thrive.
Navigating a shift to VBC can be complex. agilon health is purpose-built to help physicians maximize the potential of VBC for their practices and their patients.
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What are the challenges to value-based care?
Transitioning to value-based care can be challenging for the following reasons:
Collecting Quality Structured Data
The efficient collection and integration of structured data are key to a successful transition to VBC. The agilon platform collects, extracts, and shares financial, clinical, and social determinants data.
Moving from a fee-for-service model to value-based care can be complex and can initially involve risk to a provider, as value-based reimbursement entails changing the way a practice receives payment. Physicians who partner with agilon health benefit from a full-risk capitation total-care model.
While the use of value-based care is increasing in the majority of health care organizations, it is often still competing with fee-for-service models. Physicians can be impacted differently by the two models, which can create operational discord. Physicians who work with agilon health gain a partner that helps them integrate seamlessly with health systems and payors.
What are some barriers to patient care?
Access to care is the biggest barrier that patients face. If a patient cannot access their physician, it is impossible to receive medical care and resolve health issues.
Factors affecting patient access to care include limited appointment availability, geographic obstacles and clinician shortages, lack of transportation, and insufficient education about health systems and care sites.
How does value-based care affect patients?
Value-based care stresses an integrated team-based approach to medicine that benefits a patient by emphasizing preventive care and wellness. With the focus on preventing problems before they start, patients often develop healthier habits, which can lower health care costs as well as increase patient satisfaction.
With value-based care, hospitalizations and medical emergencies often decrease, which leads to a healthier population, ultimately benefitting all.
How does value-based care affect vulnerable populations?
Value-based care helps vulnerable populations and those in underserved communities by providing a support network that can help lessen health risks and promote wellness.
Instead of treating specific conditions, value-based care focuses on the individual with a whole person approach to care so that a patient can experience improved health and better outcomes.