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

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.

1. 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.

1. 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.
2. 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.
3. 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.
4. Standardize documentation procedures. Consistent documentation is increasingly important in transitioning to value-based care, as reporting requirements are becoming more complex. Making certain all providers within a practice are documenting activities the same way in the EHR is essential for clinical assessment, quality care, and seamless patient transition from one team member to another. This is especially important for after-hours care, as on-call physicians need quick access to health records for all patients in the practice. If all physicians are documenting care and treatment history the same way within the EHR, it is easier for on-call providers to interpret records and ensure that appropriate follow-up care occurs.
5. Build strong relationships with referral partners. In a value-based world, providers are part of a larger community responsible for the full spectrum of patient care. Consequently, they need to work together to share information about what happens to their patients outside of their clinics. Maintaining close connections with such referral partners as palliative care specialists, hospice workers, home care aides, social workers, and others is an essential aspect of patient navigation and ensures appropriate care while minimizing hospital admissions and emergency department visits. Practices must also utilize interoperative technologies so patient information can easily be shared.
6. Engage strong clinical and administrative leaders. Strong leadership is important in both the clinical and administrative areas of the practice. Not all physicians adapt well to the changes required for value-based care. A strong physician leader can mentor peers to help ensure broader provider buy-in. On the administrative side, a highly-skilled leader can effectively coordinate both clinical and administrative staff, nurturing the collaborative team culture necessary for successful value-based care.

Closing Thoughts

Value-based care is not going away, and it will continue to evolve in various forms in the future. To thrive in this new environment, practices need to embrace this new reality sooner rather than later. By participating in pilot programs and other value-based initiatives, practices can play a critical role in actively developing and defining these new models of care and reimbursement.

If the transition to value-based care is overwhelming and negatively affecting the practice’s ability to deliver quality care, it may be time to get help. The move away from fee-for-service requires massive top to bottom changes, and the task can often be made much easier with guidance from experts. Assistance is available from organizations like McKesson Specialty Health, which offers comprehensive services, expertise, and technologies to help oncology practices make the necessary changes to prosper in the new value-based environment.

Linda Pottinger is director of operations for Innovative Practice Services at McKesson Specialty Health.