Value-based care is quickly approaching the tipping point – and is pegged to become the dominant model of care in the not-so-distant future. The big question: Are healthcare organizations ready to leave fee-for-service behind and fully embrace this new model?

This issue was addressed during The Health Innovation Think Tank, Adoption and Policy at a Crossroads, which was held at the UPMC Center for Connected Medicine in Pittsburgh, on October 10th. Co-hosted by Lenovo Health, Justin Barnes Advisors, Center for Connected Medicine (CCM), Inventiv Health and HIMSS Media, the event brought some 50 healthcare delivery system, payer organization and healthcare IT vendor thought leaders together to offer their insights on a variety of pressing industry issues.

Under value-based care models, healthcare organizations need to improve outcomes and patient satisfaction while delivering care in a cost-efficient manner – as opposed to simply providing a greater volume of services. As such, “many hospitals and physicians will be operating at risk. And, that is something they might not be prepared for. So, they need to reinvent themselves in the context of delivering value-based care,” said Tom Foley, director, global health solutions at LenovoHealth.

To succeed, the primary care physician should take the lead in managing care, according to Daniel Brooks, co-founder of CURA Management. “You need the provider’s perspective. The primary care doctor is often best qualified to manage care,” he said.

Putting the physician in the driver’s seat, however, requires significant cultural change. Holly Miller, MD, chief medical officer at MedAllies, pointed out that this transformation requires provider organizations to become more patient centered, participate in team-based care and implement continuous quality improvement programs.

Comprehensive Primary Care Plus (CPC+), a national advanced primary care medical home model that aims to strengthen primary care through regionally based, multi-payer payment reform and care delivery transformation, is one “brilliantly designed” program that is helping to move the industry toward such transformation, according to Miller. The program offers a care management fee that helps provider organizations “bulk up their bench” by hiring a variety of professionals such as behaviorists, nurse care managers and pharmacists – all of whom can help deliver patient care.

“About 20 percent of acute and chronic visits do not require physician intervention,” Miller said. “If the team is managing these patients that means the physician can be focused on what physicians do best – building relationships and making complex medical decisions.”

CPC+ also includes payment innovations that help to support value. For example, the program reimburses physicians for various care management activities, encourages physicians to decrease utilization and prompts improved quality through a shared savings element. “Value equals quality over costs,” she said, while pointing out that CPC+ is designed to facilitate this equation.

Health systems also are dealing with the emerging realities of value-based care. At the University of Virginia Health System, that means transforming service strategy to ensure that it lines up with patient needs under value-based models. More specifically, to align information technology with value-based care, the health system is implementing connected health and virtual care technologies.

The key to succeeding in such endeavors stems from concentrating on putting the patient at the center of care while also “solving the right problems” and “not trying to boil the ocean,” said Leigh Thomas Williams, administrator, business systems, health information & technology at the Charlottesville, Va.-based organization.

For example, the health system has implemented an online patient care hub, a mobile, web-based document repository that collects and organizes relevant patient information – giving both patients and providers an easy way to manage care activities. “People with HIV have complex care scenarios that they are trying to manage. Many of these patients deal with 10 different specialists,” Williams said.

The health system also has provided large-sized tablets to stroke patients, which enable those from rural communities to connect with caregivers “in the moment.” By providing such connectivity, patients can consult with their providers at any time, making it possible to decide the right course of treatment – whether that means going to the emergency department or simply taking medication and lying down.

The initiative did not require a huge investment nor was it difficult to implement, according to Williams, but it “could make a difference” as somebody’s “grandmother might be at Thanksgiving this year” because she was able to better manage her health by using the mobile device to connect to care providers around the clock. 

Under value-based care models, healthcare organizations not only need to improve care outcomes, they need to do so in a cost-effective manner. As such, healthcare organizations should concentrate on leveraging data to zero in on who their patients are, what they need and what resources are made available to them, according to Pamela Peele, chief analytics officer at UPMC Health Plan and UPMC Enterprises. “If you don’t have the data, you are just shooting in the dark,” she said.  

UPMC, for example, uses claims and other data to determine the topology of chronic conditions in specific geographic areas. As such, leaders can look into the “mountains and valleys of chronic diseases” to determine specific geographic areas that have a high prevalence of diabetes, cancer or chronic obstructive pulmonary disease. UPMC then matches how it deploys its resources to specific needs to cost effectively deliver targeted services.