Industry Voices—3 questions providers need to prioritize as they look to take on more risk

As healthcare providers consider lessons learned from the pandemic and their value-based care strategy for 2020, there are an array of considerations that can and should become top of mind as they plan ahead for 2021.

Based on my work with leading healthcare provider organizations like Devoted Health, AdventHealth, and Monogram Health, I have garnered a deep understanding of the complexities of transitioning from fee-for-service to value-based care (VBC). We all know that this journey is unique to every organization, so there is no formulaic guidance that any vendor or consultant can provide when it comes to your organization’s VBC strategy and infrastructure. 

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There are, however, a series of challenges that I have consistently managed with provider partners that should be top of mind for each organization looking to further take on risk in 2021. Those challenges and corresponding considerations include: 

  • Can more data help or hurt my organization in streamlining the transition to VBC? Many organizations think that the more data they can gather and assess, the better. Quite frankly, that can be a misguided use of time and resources. Instead, provider organizations would be better served to look at a maximum of 12 to 18 months of data, which tends to maximize the signal-to-noise ratio, to better determine opportunities to optimize patient outcomes and take on more risk. 
  • What will it take to get physicians to adopt VBC changes? Leadership teams within provider organizations often underestimate the difficulty of getting physicians to adopt new behaviors that align with their VBC strategy. The reality is that physicians have already adopted new behaviors as a result of the transition from paper to digital records. More so, physicians are constantly being asked to add more onto their plates—even during a pandemic. If providers want physicians to adopt new behaviors that align with their VBC strategy, they should be thoughtful with their incentives. Physician leaders should be closely involved in the VBC planning process so that their point of view is fully integrated into the overarching plan to take on more risk.
  • Do we (as providers) know more than the vendors and consultants we are hiring to support our risk strategy? While I mentioned earlier that each provider organization is unique, the reality is that the best practices provided by many vendors and consultants on the leading edge of the transition to VBC have great insight. Undoubtedly, these best practices will need to be tailored, but there is still consistency in how to approach VBC-specific challenges. For example, my team has adopted a three-step best practice grounded in a clinical-first workflow over the last several years. Oftentimes, our provider partners align with this best practice approach at the buying stage but then drift during implementation. This deviation can impact the clinical and financial outcomes—and extends the path from implementation to return on investment.

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In addition to these three questions listed above, provider organizations would be well-served to also consider whether they have the right team and the right electronic health record in place and if they are truly prepared with a business model to fund a VBC transition that will take 18 months to two years.

The journey to value-based care is just that—an arduous venture. The provider organizations that ask the right questions, bring together the right team, and plan for the long game in VBC and risk-contracting will win.

Dr. Matt Lambert brings more than 20 years of experience as a clinician, CMIO, and change leader in value-based care, ensuring that patients receive more comprehensive care and that payers and providers better capture the value of their services. He is a practicing, board-certified emergency medicine provider who previously founded his own physician staffing company - and is the Chief Medical Officer at Curation Health. He is also the author of two healthcare books: Unrest Insured and Close to Change: Perspectives on Change and Healthcare for a Doctor, a Town, and a Country.