Empower Your Value-Based Care Journey to Success
Value-based care (VBC) is increasingly recognized as a transformative approach in the healthcare industry, aiming to shift the focus from volume to value, improving patient outcomes while controlling costs. However, the success of value-based care initiatives often hinges on a key factor: the demonstrated commitment from providers. According to Mike Jasperson, Senior Vice President of Provider Network and Health Plan Operations at Priority Health, the dividing line between successful and failed VBC initiatives is clear. In this blog, we will explore what separates value-based care successes from failures and how healthcare organizations can navigate this complex landscape.
The Importance of Commitment in Value-Based Care
The Role of Provider Investment
For value-based care models to thrive, providers must be more than just participants—they must be deeply committed to the process. Jasperson emphasizes that merely hoping a value-based contract will work out is not a viable strategy for success. “That is not a recipe for adding value to the communities we serve,” he notes.
The commitment required from providers often involves significant investments in infrastructure and technology. This includes areas such as analytics, pharmacy services, and electronic medical records (EMR) platforms, which are essential for managing patient care effectively at the point of service. Providers who are willing to make these investments move beyond traditional fee-for-service models, focusing instead on transforming care delivery and improving patient outcomes.
Priority Health’s Success in Value-Based Care
The Corewell Health Partnership
One of the standout examples of successful value-based care is the partnership between Priority Health and Grand Rapids-based Corewell Health. In 2020, Priority Health launched a full-risk contract with Corewell Health, covering 170,000 lives across various markets, including Medicare, Medicaid, commercial, and individual sectors. The results have been remarkable.
By 2022, this partnership had achieved an estimated $45 million in healthcare cost savings. Additionally, the program reduced hospitalizations by 6% and emergency room visits by 2%, while increasing primary care visits by 15%. These results underscore the effectiveness of a fully integrated value-based care model, which, according to Jasperson, is possible due to the deep integration between Priority Health and Corewell Health. The contract also accounts for over $1 billion in premium revenue, further highlighting the financial viability of such arrangements.
Challenges Facing Value-Based Care
Capital Shortages and Provider Shortfalls
Despite the success stories, value-based care is not without its challenges. A significant barrier to wider adoption is the shortage of capital. Joshua Kaufman, MD, Medical Director of Behavioral Health and Medical Integration at Capital District Physicians’ Health Plan (CDPHP), explains that capital can refer to both financial resources and human resources. “There’s a shortage of providers, and there’s a shortage of money to pay the providers,” he says. This scarcity makes it difficult for organizations to feel comfortable taking on the risks associated with value-based care.
Educational Initiatives for Opioid Use Disorder Treatment
CDPHP has implemented value-based payments for primary care providers treating opioid use disorder, offering additional payments of up to $188 per visit. However, financial incentives alone are not enough. To address the discomfort some providers feel in prescribing controlled substances for opioid use disorder, CDPHP launched the “Courage to Care” program. This initiative includes a series of webinars designed to educate providers on medication-assisted treatment (MAT) for opioid use disorder. According to Dr. Kaufman, combining financial incentives with rigorous education was key to increasing provider participation and comfort with MAT.
Strategic Approaches to Value-Based Contracting
Risk Assessment and Selective Partnerships
Not every healthcare organization is equipped to handle full-risk contracts. To navigate this, Priority Health developed an alternative payment model index that helps assess the level of risk an organization can reasonably take on. Jasperson emphasizes the importance of viewing these contracts as partnerships, where both parties have a vested interest in success. “Simply throwing risk over the fence to another entity doesn’t make sense to us,” he explains.
Over time, Priority Health has refined its approach to value-based contracting, becoming more selective about the deals it enters. Jasperson notes that a successful value-based contract must be a “win-win-win” for the provider, the insurer, and the community served. This vigilant approach ensures that Priority Health invests in the right partnerships, ultimately leading to more successful outcomes.
Conclusion
The success of value-based care initiatives depends on several factors, with provider commitment and strategic investments standing out as crucial elements. Priority Health’s partnership with Corewell Health serves as a model of how integrated, full-risk contracts can lead to significant cost savings and improved patient outcomes. However, challenges such as capital shortages and provider education must be addressed to expand the reach of value-based care. By adopting a strategic approach to risk assessment and partnership selection, healthcare organizations can increase their chances of success in this evolving landscape.
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FAQs
Q1: What is value-based care (VBC)?
A1: Value-based care is a healthcare delivery model that focuses on providing high-quality care while controlling costs, shifting the focus from volume to value.
Q2: Why is provider commitment important in VBC?
A2: Provider commitment is crucial because it often involves significant investments in infrastructure and technology, which are necessary for effective care management and improved patient outcomes.
Q3: What challenges does VBC face?
A3: Some of the challenges include capital shortages, a lack of providers, and the need for more education around specific treatments, such as medication-assisted treatment for opioid use disorder.