Value-based Care Management

For the past, several years the shift from fee-for-service has transitioned to a pay-for-performance model. Currently, the pay-for-performance model also known as value-based care, is being recognized as the preferred payment model. Value-based healthcare is a delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. The cost of healthcare has become the biggest concern for patients as well as healthcare providers throughout the nation. Finding a solution to lower cost has been the priority to solving the many issues the fee-for-service or volume-based model has created for healthcare. Value-based care has already proven to be more beneficial for physicians and patients. The idea of collaborative care and coordination is what’s winning providers and patients over.

Historically, volume-based care was the standard payment model. The payment system was heavily based on being rewarded by volume. Traditionally, the reimbursement payment models were more focused on the quantity of services rather than the quality. Currently, there is a shift that is happening where quality of service is becoming more of an attractive model than quantity. The payment model that healthcare is focusing on is Value-based care (VBC). Now more than ever hospitals and external organizations and payment models are pushing VBC.

Organizations

  • American College of Surgeons (ACS)
  • Centers for Medicare & Medicaid Services (CMS)
  • Healthcare Career Advancement Program (HCAP)
  • Joint Commission
  • National Surgical Quality Improvement Program (NSQIP)
  • National Quality Forum (NQF)
  • Society of Thoracic Surgeons (STS)
  • Strategic & Competitive Intelligence Professionals (SCIP)

New Payment Models

  • Accountable Care Organizations
  • Bundled Payments
  • Clinically Integrated Networks
  • CPT based bonuses and penalties
  • Governmental Penalty Programs
  • Incentives for moving procedures to the Ambulatory Surgery Centers and Office
  • Value-Based Purchasing

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

Fragmented Healthcare vs. Value Based Healthcare chart

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
  • Governance for Value

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

Results