A Step-by-Step Guide to Value-Based Care

Linda Pottinger
Published: Thursday, Oct 27, 2016
Linda Pottinger

Linda Pottinger

The evolving healthcare landscape creates many challenges for community-based oncology practices. As the market shifts from fee-for-service to value-based care, practices are tasked with improving quality while reducing costs. They must also report on a multitude of clinical and financial performance metrics, a complex undertaking if not properly managed.

How can independent practices successfully make the move to new care and reimbursement models while remaining focused on their primary mission of providing quality care? In supporting community-based practices, McKesson Specialty Health has identified eight core activities on which practices should concentrate to ensure a smooth, successful transition to value-based care:
  1. Build a collaborative, patient-centric culture with a team approach to care.

    Collaboration and team care are critical to all value-based care programs, and practices should strive to build a culture that supports this environment. In the past, clinical and administrative functions were often siloed. Today’s value-based care models drive a whole new way of doing business by recognizing that every practice member has a role in providing care and value to patients. From the front office team to physicians and the supportive care team, staff must collaborate to provide patients the best possible care and experience while ensuring all requirements of the value model are met.

  2. Educate practice staff and physicians so they understand value-based care.

    Physicians and staff must thoroughly understand value-based care and the role they play in its success. Practices also need to understand how the industry is evolving and the processes required to address new care delivery models. Value-based care is not solely about reducing costs; it includes higher quality coordinated care, smarter spending, and ultimately better outcomes for patients. Education is essential to creating a culture that seamlessly merges value and quality.

  3. Develop strong patient navigation and follow-up processes.

    Physicians must be responsible for ensuring patients receive the care they need when coordinated care extends beyond their practice’s specialty. Referring patients to another provider is not enough—there needs to be a process in place to confirm that care is delivered and that there is appropriate follow-up on the outcome of that care.

    Consistent patient navigation and follow-up processes are critical, as is having staff members who are truly responsible for these functions. Patient navigation is most effective when each team member understands his/her role in the follow-up process.

    Mental, financial, and nutritional care are important elements of patient navigation, ensuring patients receive the full spectrum of care for body, mind, and spirit. Ultimately, the goal is to develop a circle of care around a patient, providing the best possible outcome, patient experience, and quality of life while reducing unnecessary emergency department visits and hospital admissions.

  4. Participate in quality programs

    By participating in value initiatives, such as ASCO’s Quality Oncology Practice Initiative and payer-driven Alternative Payment Models, practices have already begun building a strong foundation for value-based care, since these programs include measurement tools and data elements to define quality. Practices should review various program requirements against their current reporting capabilities, identifying data elements that are already being captured while determining where gaps exist.

  5. Establish solid front office and billing procedures with advanced reporting capabilities.

    Successful practices must have strong front office and billing leadership that supports a value-based culture, along with technologies that enable advanced reporting of critical value-based care metrics. Staff members must thoroughly understand their practice management and electronic health record (EHR) systems, what value-based care is, and their responsibility in delivering that care. Front office staff members are typically the first point of contact with patients, and as such play a critical role in beginning the patient practice relationship. In addition to collecting all of the required demographic and insurance information, front office staff also may be responsible for collecting necessary medical records from the referring physician, ensuring that clinicians can deliver the appropriate level of care. Counseling on financial matters and documenting these conversations are important components of value-based care and are usually performed by front office staff.

  6. Standardize documentation procedures.

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