This Month in Healthcare IT: Value-Based Care

December 1, 2020 | By Wendy Bartlett

This Month in Healthcare IT_ Value-Based Care

The transition from volume-based to value-based care has been a key area of focus for healthcare leaders in recent years. Providers of all sizes, from small healthcare practices to large health systems, are looking for efficient and effective ways to embrace value-based reimbursement, overcome barriers, and improve their quality of care as a whole.

As they attempt to navigate the shift to value-based care models, care professionals consistently seek guidance, resources, and healthcare IT tools to help make it a reality. However, ensuring a successful transition to value-based care requires providers to stay up to date on breaking news, best practices, and innovations in the field. 

To help you keep current, we compiled a list of the latest value-based care news to hit the headlines:

1. Workforce Management and Development for Value-Based Care

In spring 2021, more than 1,200 healthcare leaders will convene in Washington, DC, for the 17th Annual World Health Care Congress (WHCC21). According to the event website, this year’s meeting will focus on “keeping care delivery and payment transformation front and center by sharing strategic initiatives, results, and steps to overcome access and affordability issues while delivering high-value care.” 

Specifically, many of the WHCC20 speakers will discuss all things value-based care, covering topics like transforming primary care with value-based payment models, surprise medical bills, consumer-driven health plans, the promise of value in healthcare, reinventing care delivery, improving payer-provider collaboration, price transparency, and more. It will be interesting to see key takeaways and insights gleaned during the conference, as well as the approach that healthcare professionals will take in response. 

2. Humana Accelerates Value-Based Care Strategy with Home Health Providers, Others

Humana, a well-known U.S. insurance company, continues to shift operations toward value-based care payment models, both through external provider partnerships and internal service lines. Results have been great so far. In Q3 of 2020, 86 percent of Humana’s value-based care partners received a surplus or higher level of payment than they would have in a fee-for-service arrangement. 

According to President and CEO Bruce Broussard, The Medicare Advantage (MA) program incentivizes a “holistic focus on health,” presenting an opportunity to partner with providers on value-based care models customized to their local market and risk tolerance. Currently, approximately two-third of Humana’s MA members are cared for by providers who have value-based arrangements in place, which will hopefully continue growing well into the future. Looking ahead, Humana will also increase its focus on the social determinants of health (SDOH).

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3. CMS Direct Contracting Model Options for Value-Based Care

Recently, the Centers for Medicare and Medicaid Innovation (CMMI) created the “Direct Contracting Model” to expand on opportunities for organizations to participate in value-based care arrangements. The goal of the new contracting model is to ensure that the next generation of risk-sharing arrangements improves outcomes, lowers costs, and encourages high-quality care.

To effectively manage patients in the new model, participants should coordinate with other providers across various care settings, plus take action to deploy timely interventions that support patients’ health and well-being. Real-time data will offer a new level of clinical intelligence to ensure seamless care transitions while creating optimal cost-saving opportunities.

4. The Pandemic boosted interest in new payment models. This startup developed tools to help manage those complex contracts

Apervita, a healthcare IT startup focused on data analytics, recently rolled out a new digital solution called QPay, which is designed to improve transparency and help providers and payers better manage complex, value-based payment arrangements. The cloud-based platform will help summarize key contract terms, offer performance insights, and help minimize the risk of reimbursement disputes.

Provider cash-flow concerns amid the COVID-19 pandemic have resulted in reignited interest in value-based care. The hope is that technology for simplifying contract terms will build on payer-provider collaboration and improve how organizations manage their value-based arrangements.

5. Blue Cross NC expanding its Blue Premier value-based care program to rural providers

Blue Cross and Blue Shield of North Carolina (BCBSNC) is partnering with Caravan Health to offer the Blue Premier program to community and rural providers. Through an established joint accountable care organization (ACO), the companies will allow value-based care initiatives to reach community and rural hospitals. 

The goal of the project is to make the benefits of value-based care more readily available to BCBSNC members, improving access to quality, affordable care. Through the new ACO, rural providers will receive assistance with both care coordination and chronic care management, allowing them to share in savings achieved through value-based care.

Value-based care is ever-evolving like many other healthcare initiatives today. Subscribe to our blog to stay updated on the latest news in value-based care, population health, healthcare IT, patient engagement, and more.

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