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  • Jessie Gregorio

Our Organization is Discussing Value-Based Care Models. What are Strategies for a Smooth Transition?

This question and answer was printed in a Monroe County Medical Society 2019 Bulletin.

Over the last ten years, there has been a lot of discussion about the shift from volume-based to value-based reimbursement models. The Centers for Medicare & Medicaid Services (CMS) defines value-based care as programs that “reward health care providers with incentive payments for the quality of care they give to people with Medicare.” Programs are part of an overall strategy to provide: better care for individuals, better health for populations, and lower cost. As the healthcare system continues to evolve from fee-for-service payment models to value-based care, physicians practices will need to adapt. The transition is not easy and comes with challenges. Here are five key steps physicians should follow to successfully navigate the transition to value-based programs.


1. Introduce Risk Gradually: Value-based care requires healthcare providers to take on more financial risk than with traditional fee-for-service payment models. Shifting financial risk onto the provider will need to be incremental while investing in care management.


2. Invest in Data Management: Proper preparation and investment in data management is key to understanding the increased financial risk of value-based care. Identify patient population and understand which patients are driving highest costs. Utilizing data management to understand patient population will help identify target population and opportunities for improvement.


3. Enlist Patients: Communicate with patients and keep them engaged as active participants in achieving better care for all individuals.


4. Monitor Progress: Reevaluate, quarterly and annually, how well the practice is achieving predetermined goals of improved patient care and better health outcomes.


5. Collaborate: Consider partnering with hospitals, urgent care centers, physician groups, or other organizations to enhance provider resources, communication and coordination across the continuum of care. Bonus tip: consult an attorney to review any contracts with payers as there may be regulatory requirements to consider.


Value-based care is transforming the healthcare industry. Although providers may face challenges in transitioning to the new model, proper planning and monitoring progress will ensure success so that patients and providers can reap the benefits of value-based care.


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