Skip to main content

Evolving care delivery and value based payment models

Navigating evolving care delivery and value based payment models

According to the CMS innovation center, there are 12 state level and 31 facility level models underway resulting in appx 12K entities participating in various payment and delivery innovation pilots. In addition there were approximately 40 other models that are no longer active. There is but one foregone conclusion - there is no one-size model that fits all situations. We all knew that!

Below are 10 practices from high performing healthcare organizations to successfully navigate the evolving care delivery and value based payment models.

  1. Understand the individual member: Understanding the member requires more that arming them with easy to use technology solutions. The easy to use technology does go a long way to connect the last mile, however understanding the member means understanding their motivations for being healthy, understanding their environment, their family situation. These factors are not only key to understanding the causes of poor health, they are also vital to designing care pathways for holistic and effective care of the individuals.
  2. Design meaningful care pathways: Not all care needs to be delivered in formal settings, or is clinical in nature. Designing care pathways that integrate the individual member’s personal situation into the care regimen can not only improve their quality of life and outcomes, but can also lower the total cost of care. 
  3. Understand and anticipate impact on performance measures: Depending on the program’s design, some performance measures may deteriorate initially as preventative actions introduced early on in the pathways would result in only higher severity cases entering the system. Additional analysis may be required to understand the root cause of deterioration.
  4. Be selective about pilots: Invest in pilot programs based on the organizational goals and strengths; those may be cost savings or outcomes or member experience – recognize that the organization may not achieve all of “triple aim” in the same pilot. Not all pilots may be scalable to the full population.
  5. Validate organization readiness: Understand the gaps in the operational environments (people process technology and data) in one’s own organization and those of other entities in the care network. Keeping organizational goals in mind, identify capabilities that the organization should build, buy, rent or partner. 
  6. Convert data to information: Making the right data available to the physicians and patients in an easy to consume manner that is timely and provides key insights to make informed decisions will not only help in the present but also decrease risks of poor outcomes in the long term.
  7. Leverage technology and finance functions from the start: Technology can deliver meaningful pathways that integrate formal and informal care settings, while finance assesses the viability of the solutions. Together these inform the long and short term investment prioritization.
  8. Reuse and repurpose: Take inventory of existing assets and capabilities in the organization to reuse and leverage organizations learning.
  9. Make the systems simple and easy to use for all levels of end users
  10. Transparency and trust in convergence: Transparency and trust are key to convergence of care delivery and payments in the evolving models. The facilities collaborating with CMS’ and other commercial entities innovative initiatives are learning a lot from each other.

 These are easier said than done, but with strong organizational will, disciplined execution, and persistence they are well within reach. These will also yield meaningful contracts among the participating entities and lead to Affordable & Accountable Healthcare!

Share On

Posted By Anita Ballaney

comments (0)

leave a comment