The essence of VBC lies in data-driven decision-making

The value-based care payment and care delivery model has been evolving for more than a decade, and with the right risk tolerance and aligned incentives, it promises to benefit patients, providers and payers.

“While the adoption has been windy, there are clear signs of VBC’s stickiness and growing footprint,” explained John Fryer, chief revenue officer at Lumeris, which focuses on the accelerated adoption of value-based care. 

As president of Tribus, he focuses on helping physician practices take on advanced risk-sharing arrangements. In the following Q&A with Healthcare IT News, Fryer offers insights and advice on aligning incentives that deliver the highest level of clinical and financial results.

Q. Do you think progress toward VBC will accelerate after what many think has been a period of stalling/stagnation in recent years?

A. With investment in value-based care more than quadrupling from 2019 to 2021, the government, payers and providers continue to embrace these models. 

As the Center for Medicare and Medicaid Innovation issued an ambitious goal to shift 100% of Medicare beneficiaries into an accountable care relationship by 2030, it remains clear that broader adoption will continue. Couple this with the fact more than 10,000 individuals become Medicare eligible every day, the impending reimbursement pressure on our delivery systems will continue to push more and more adoption of value-based models.

Q. As contracts evolve and providers take on more risk, how can payers ensure that risks are manageable and best support providers so they are successful?

A. As the healthcare landscape shifts, payers have a responsibility to ensure that contracts with providers create alignment across all primary stakeholders: the payer, the provider and the patient. 

The benefit of risk contracts is they can be designed with a patient-centric approach, offering incentives that motivate providers to enhance care quality and accessibility, while understanding and managing the costs to deliver that high-quality care. 

For these strategies to be successful, payers must enable the providers to be successful. From our perspective, this enablement is all driven by what we refer to as the Collaborative Payer Model. It is built around three primary elements: radical alignment of incentives between payer, physicians and patients; complete clinical, financial and comparative performance transparency; and reciprocal responsibilities and accountability.

In recent years, some providers and payers have begun to chip away at years of built-up distrust through more aligned, risk-based partnerships. With the right risk tolerance and aligned incentives, these risk-based partnerships are positioned to be a win-win scenario for patients, providers and payers. 

Q. What are some ways to ensure metrics are credible and incentives meaningful enough to drive improved performance?

A. Creating performance measures/metrics that align performance incentives from payer to network to provider is one of the most important activities to driving value-based care success. 

Measures need to be clearly defined before the performance year, monitored (at a minimum) on a monthly basis, and most importantly, relevant to improving the clinical outcomes of the populations served. To do this, organizations should focus on a consistent set of measures that allow providers to monitor and track progress over time. It is far too common that organizations manage more than 50 different measure sets for different external stakeholders with no enterprise alignment on where to focus. This leads to confusion, lack of prioritization and a struggle to drive improvements. 

The focus should be on ~10 measures that impact quality for value-based outcomes with a standardized measurement approach, and a clear process for how the measures are shared with the care teams.

Aligned incentives are designed to reduce conflicts of interest in value-based care. Core to driving these behaviors and competing in this new environment is creating a physician compensation model that allows physicians to be rewarded in accordance with the total cost of care value (medical margin) they create.

The medical margin share for VBC models should align a majority of value creation to the work that individual providers are delivering to achieve the desired outcomes. For primary care providers, a minimum of 30% of the total take home pay should be tied to these value-based monies. In mature markets, primary care providers can see much more than this as their panel shifts towards predominantly serving patients in value-based arrangements. 

Q. How can physicians help facilitate the success of their VBC contracts, and what are some ways they are leading efforts within their primary care organizations?

A. Physicians and their care teams are fundamental to the success of their VBC contracts by actively engaging in the management and performance improvement process to accelerate improvement and identify new opportunities. Lumeris believes this process begins with the governance model of the provider network ensuring that individuals are organized in a fashion to effectively participate and drive long-term success of the value-based model. This requires the identification and growth of physician leaders and allowing them to shepherd groups of organized providers with the right information to be able to drive action.

With this pivotal role in the success trajectory of value-based care, physicians’ adaptability and commitment to reshaping their practices are instrumental in enhancing care quality and cost management. As these physicians accrue experience and demonstrate success, the group participants can be broadened to cater to a larger VBC patient base. 

Q. My understanding is providers need support in understanding and interpreting population health data. What supports are available, and what needs to happen to connect value-driven providers to information that can identify improvement opportunities?

A. The essence of VBC lies in data-driven decision-making. To this end, technology and analytics platforms must furnish providers with timely, actionable insights. These platforms should champion transparency, shedding light on cost structures and performance metrics across the entire care spectrum.

Given the complexity of population health data, providers need robust support systems to decipher and leverage this information. Integrating the right analytical tools into their daily workflows can significantly enhance decision-making efficacy. 

A requirement for success in value-based care is full transparency of payer and provider data that creates a comprehensive view of the populations attributed to these models. One of the historic challenges of VBC was the inability to access this “complete” picture as the data was stuck in various silos across the continuum (stuck with the payer, stuck with the provider and stuck in platforms outside the purview of the key stakeholders). Fortunately, the technical limitations that previously existed have continued to be broken down over the last five years, and today it is possible to have a 365-degree view of patient populations. 

Organizing the data to provide this 365-degree view is just the first step in the process. 

Providers in value-based care require an analytics engine to take advantage of this information and turn it into actionable insights that can impact decisions that are made at the group, subgroup, pod, individual practice and provider level.

Taking it a step further, being able to understand the data at a person level and the social determinants that may impact this individual, providers are able to incorporate analytics and insights at the point of care to drive specific interventions that will remove potential barriers in key populations where this may have a greater impact.

Q. Since fee-for-value is driving changes to care teams’ daily, weekly and monthly routines that technology can support, what are your tips for training and clinical mentoring that can deliver accountable primary care? 

A. Providers need substantial support as they take on new tasks associated with managing a patient population in terms of cost and quality. 

Role-based playbooks and interconnected technology tools can help the care team understand their routines. Training, on-the-ground support and clinical mentoring are essential to facilitate change and deliver true accountable primary care. This is often accomplished in key phases, including provider boot camps; onsite, near-site and virtual learning opportunities; and most importantly, the ability to engage with other physicians operating in a mature value-based model.

The ability to see it and feel it in action can accelerate the time to transformation. Engaging the entirety of the clinical and administrative teams that support accountable primary care practices is the secret sauce to driving transformation to value-based care models.

Lumeris has designed an engagement model that encompasses all members of the team and is encapsulated in role-based playbooks that are the foundation for kicking these efforts off. Marrying best practices and playbooks with boots-on-the-ground support of subject matter experts can help the practices utilize the breadth of technology and analytical tools to solve challenges. As value-based models take hold, the impact will be felt by all. 

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.