Value-based Care Management

Hospitals and health systems are under significant financial pressure due to a confluence of recent industry challenges, including regulatory actions, cost pressures, consumer expectations, and of course the recent pandemic. In light of this, the industry is experiencing an acceleration in the shift from fee-for-service (FFS) to value-based care. Providers are recognizing the benefit of diversifying revenue streams, creating a more sustainable business model that can be successful in our new environment. Payers are looking toward value-based care as a way to improve quality while reducing costs. This can be seen in CMS’s proclamation that they aim to move to 100% of Medicare providers into two-sided risk arrangements by 2025 and half of its Medicaid and commercial contracts into value-based care models within the same period.

Surgical services have the opportunity to make a substantial impact on their hospital’s financial margin while delivering even better clinical outcomes by taking meaningful steps towards value-based care.

Hospital’s financial survival depends on quality outcomes from perioperative services

Surgical Directions chart displaying perioperative services financial impact

Fragmented care led to our current situation with the new mandate to shift to value based healthcare. Surgical Directions understands that VBC is imperative and can support healthcare organizations along their journey:

Value-based surgical care will require innovative investment, such as:

  • Focusing on the consumer
  • Transforming hospital care into high value process
  • Virtual care innovation
  • Patient engagement technology
  • Developing advanced analytics

Investment needs to be supported by a collaborative team that includes provider, nursing, and administrative leadership. Surgical Directions can help your healthcare organization determine where to invest and what organizational structure and governance are needed to drive meaningful change.

Surgical Directions’ offerings in the VBC arena include:

  • Perioperative Surgical Home – Launch and sustain a team-based model of care that coordinates the patient’s entire surgical experience from decision to have surgery through 30-90 days post discharge
  • ERAS Implementation – Assist perioperative care teams in standing up end-to-end Enhanced Recover After Surgery (ERAS) protocols across one or more service line
  • Organizational Design for Value- Align your organization’s operational structure, clinical service lines and affiliated infrastructure to be able to be successful in a Value Based Care model.
  • Governance for Value – Design and implement the necessary governance practices and organization model to help ensure a smooth transition to Value Based Care

The benefits of VBC

  1. Achieve better financial outcomes – Lower total cost for the episode of care and reduced penalties
  2. Enhance patient experience – Higher satisfaction scores and improved return to prior or improved functional status
  3. Increase in internal efficiency outcomes – Reduce delays, fewer cancellations, and lower length of stay
  4. Improve clinical and safety outcomes – Fewer complications, lower readmissions rates, and reduction in opioid use
  5. Respond to government mandates around risk-based payments
  6. Improve public perception by addressing high cost care and the opioid crisis
  7. Drive higher surgeon satisfaction and loyalty