The shift away from fee-for-service provider reimbursement now impacts all constituencies across the U.S. healthcare industry, according to Kevin Arner, chief strategy officer at Global Health Alliance, which operates value-based care programs for physicians, insurers and employers.
“Fundamental market economics have changed irreversibly,” Arner said during Health Data Management’s Value-based Care Conference in Dallas on Wednesday. However, the shift that started as a government mandate now presents opportunities for providers to improve the quality of care and patient outcomes.
The goal of VBC should not just be about compliance with mandates, as compliance fails to be true driver of value—it simply helps an organization protect what it has, he explained. A VBC program also must be strategically aligned with a focus on outcomes and sustainability. “The complexity and adaption of these models will be challenging,” he cautioned.
VBC models should build on incremental changes, according to Arner. These include a focus on maintaining and maximizing revenue, correlation of compliance costs for administrative and clinical services, metrics to assess clinical performance and educate physicians, structured metrics with frequent intervals for reporting, and governance policies that focus on incremental improvements and transparency.
Achieving sustainability requires a focus on continuous quality improvement of patient experiences and outcomes across risk categories. Care must be broad and mixed with clinical appropriateness, efficacy and efficiency.
Quality governs everything in value-based care, Arner said. Value is defied by quality and delivered through care, which enables having predictability in lower costs over time, investing in care quality and delivering access to care, while offering mutual profitability to providers and payers.
Over time, with a strategy to engage patients—supported by the launch of a public awareness campaign—and the monitoring of patient progress, more variables become controllable, risk starts to decline and financial potential begins to build. Importantly, Arner added, complexity becomes more manageable as programs and systems mature.
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