The transformation to value-based programs involves many facets of the provider organization, from your revenue and physician compensation models to your clinical and operational workflows, documentation, analytics, and reporting. With such a widespread impact, Baker Tilly recommends establishing a value-based transformation steering committee with representation from all impacted stakeholder groups -- finance, administration, physicians, nursing, care coordination, case management, information technology etc. -- to inform, guide, and champion the change throughout the entire organization. The steering committee serves as the overall transformation management committee, with project-based operational committees designing and implementing the day-to-day activities of specific initiatives within the overall transformation program.
As your steering committee assesses its capabilities in a value-based program environment, an effective provider engagement strategy is a critical success factor in driving performance and outcomes. Your physicians will need involvement and guidance in defining new, equitable payment models based on outcome-driven quality and performance measures. By developing a comprehensive engagement strategy, you will generate the buy-in and support necessary for physicians to deliver top performance – driving higher financial returns and better patient outcomes.
Define Your Strategy
Baker Tilly’s approach to defining your value-based provider engagement strategy is based on a three-step approach: Inform > Incentivize > Drive Value.
Patient Panel Identification
- Tell your physicians who their patients are (patient alignment). Provide a stratification of a physician’s patients with key information including:
-Risk profile (SDoH, claims, labs, census data, radiology)
- Analytics of a physician’s patient panel by DRG to focus care appropriately
Scorecards and Dashboards
- Quarterly or more frequent monitoring of the activities and/or performance metrics.
- Potential metrics for PCPs: admissions, readmissions, ER visits, post d/c follow up visits within one week, AWV %, risk adjustment, quality care gaps, utilization of high cost specialists, ordering of low value services, in-network service utilization
- Potential metrics for inpatient physicians: average length of stay and excess days per discharge, readmission rates, time gaps in orders, numbers of procedures unrelated to the diagnosis, clinical documentation improvement (CDI) query response times, adjusted mortality
- easy to understand
- paid per activity or part of PMPM
- complete a task: RAF form, close quality gap, communicate with UM/CM team
Outcome-Based Model (Performance):
- receive payment based on metric thresholds for RA, Quality, Cost & Use
Establish Value-Based Network Partners
- Service Partners
- Outpatient Surgery Centers
- Ancillary services (Lab, radiology, DME)
- Patient-centered med homes
- Post-acute network
- SNF, Inpatient Rehab, LTAC, Home Care, Hospice
-Improving Patient Care Experience/Managing Risk
- Risk stratification based on the rising level of risk verus current spend is a superior method for managing risk. The approach requires the integration of EMR data in the analytics set for robust results (clinical, lab, radiology, etc.).
- Define a Care Adviser program: Transition Care, Chronic Care, End of Life, etc.
- Monitor utilization – Post acute site of care/LOS, inpatient versus observation in acute, High cost services for Onc/Cardiology, etc
- Bring the resources to the provider and patient, not the other way around. Patient and provider-centered focus means better communication and better service. For example, patient education should be onsite within the network at time of engagement.
- Central scheduling provides efficiency to the organization and all stakeholders, including patients.
Baker Tilly’s strategic approach in action
Baker Tilly’s Inform > Incentivize > Drive Value approach to provider engagement delivers a robust set of initiatives to successfully partner with your providers during the transformation to value-based programs.
- Create an informed provider population that knows which patients stratify into specific value-based programs and how to successfully manage patient outcomes to achieve maximum performance. Baker Tilly helps you optimize the input (by driving to streamline and overlap programs in your payer contracts in terms of populations, metrics, and performance criteria) and the improving clinical delivery (with accurate patient stratifications that contain identifiable quality and performance criteria).
- Effectively incentivize care delivery that drives excellent patient outcomes and efficient value-based performance. By executing on a compensation program designed with physician input and tied to contracted measurements, the organization can align its physicians and patients in the right care delivery models to achieve quality outcomes and performance results.
- Leverage the breadth of resources available to your healthcare organization and align support to new value-based care delivery models. Organizing resources to deliver quality care across the continuum drives value for your patients and your bottom line. For example, many physicians are providing point of care service, even in value-based environments. What is the organization’s strategy to support these patients through the continuum? Baker Tilly can help the organization re-imagine a support structure reinforces the physician interaction at the point of care.
Two minute self-assessment
Ask yourself whether…
- More than half of your system’s physicians (including those viewed as independents, privileged or contracted) are aligned within an organized entity that spans the entire care delivery spectrum?
- The majority of your physicians are highly engaged in all major strategic initiatives?
- You have well-defined physician participation criteria for Value-Based Care programs?
- You have any existing risk-based financial arrangements with physicians or groups?
- The providers in your network and care continuum currently share any financial risk or rewards linked to performance?
If you answered ‘no’ to any of these questions (or if you just don’t know the answer), you may not be ready to assume the risk required to successfully move towards Value-Based Care. Talk to us to find out how you can get ready.