Addressing value-based care is critical to CMS’s forthcoming mission in 2030. But providers can find it difficult to deliver equitable care while achieving it. values-based care goals.
However, providers do not have much choice as value-based care is replacing fee-for-service as a reimbursement method in the industry.
To look at value-based care from a primary care provider’s perspective, we sat down with Brandon Clark, chief strategy officer of Equality Health, a values-based care company. partner with independent primary care physicians under Medicaid contracts to take risks and relieve providers’ burdens. It has more than 3,200 PCPs in its network and partners with 25 health plans.
We wanted to know why Clark believes PCPs are the key to a successful transition from paid to value-based care, what kind of innovation and technology are needed to help providers achieve success in value-based care and how social factors determine health and what Clark calls “culturally appropriate care” is important to the service value-based care.
Q. Why do you believe primary care providers are critical to the health care industry’s success in moving from premium to value-based care?
ONE. We believe that independent primary care practices – those that are not tied to hospitals and the larger health system – are an important engine of change for the US healthcare system. move from a fixed volume-based care model to a value-based care model.
Why primary care? The primary care workforce is on the front lines in communities across the United States as both a primary and vertical point of care, especially in underserved communities where often presenting the most complex patient groups for doctors.
As the backbone of the U.S. health care system, primary care providers provide nearly all of the services responsible for helping people live longer, healthier lives. . Working with and serving local communities, they play an important role in the success of value-based care, where the goal is to provide enhanced patient care with outcomes better at reduced cost.
To help diagnose, treat, manage, and prevent chronic conditions raging across the country, primary care providers have the opportunity to see a patient’s full story, including key factors. Social determinants of health and other non-medical forces have a strong impact on health.
Keeping people healthy, managing ongoing health conditions, and keeping people away from more expensive acute care facilities like EDs and hospitals is the focal point of care success. value based.
Primary care resources across America are in the best possible position to make that happen. What is really interesting is that many of these independent PCPs have been practicing value-based care approaches. However, they are very under-resourced and unsupported, with many species on the verge of extinction.
To remain financially viable and independent, they need cooperation and tools. They need the right support so they can focus on what matters most – spending more quality and productive time with their patients.
Q. Many in the healthcare sector say the administrative burden of value-based care is enormous for service providers. With this in mind, tell me what kind of innovation and technology do you think is needed to help care providers succeed value-based?
ONE. With any significant change, there are change management efforts. Value-based contracts come with new requirements and new metrics/reports, and that puts pressure on small groups and is already overtaxed in independent primary care practices. create.
They need access to technologies that help automate labor-intensive logistics functions, identify and close care gaps in their patient table, and flag high-risk patients. or patients who may have difficulty with SDOH.
They need dedicated, dedicated support, such as practice performance managers and community health workers, to help them succeed in values-based care.
Providers are often asked to align their work around many or even dozens of different payer-specific value-based care plans. Equality Health unifies these initiatives into a single platform, integrates the practice board into a consistent value-based ecosystem, and truly transforms the way care is delivered.
At the same time, these practices need financial support. Some alternative payment models pay the provider monthly after care is provided. Innovative new approaches from cooperative institutions that take on financial risk and pay these practice incentives on time or early are very helpful in freeing PCPs from the financial burden.
For the new value-based model to work, PCPs need tools and resources that allow them to focus on delivering holistic care to their patients for better outcomes and lower costs. .
Q. Social determinants of health are critical to the future of new models of care. You talk a lot about culturally competent care. Please explain this approach and its importance for value-based care?
ONE. Racial and ethnic disparities have existed in the US health care system for centuries. The pandemic has even raised awareness of the issue, showing how important it is to take cultural factors into account when caring for patients.
To a large extent, providers and clinicians understand that culture plays an important role in prescription adherence, behavioral regulation, patient satisfaction, and how different cultural groups use use the US health care system.
However, many clinicians lack the right tools that provide practical and tangible ways to incorporate cultural beliefs and preferences into their work at the point of care. They need to incorporate culturally competent care delivery into their daily medical practice in a way that allows them to deliver better outcomes for diverse cultural groups including African Americans, Native Americans, Latinos, LGBTQ+, seniors and young adults, among others.
To account for SDOH, clinicians can interact with patients to understand the challenges they face, then analyze those findings to find common trends among different patient groups, and finally Ultimately, connecting patients with community-based organizations can help them address those challenges.
The only way to improve health outcomes and reduce costs is to reach patients with a culturally competent approach. Supporting PCPs by providing training and tools to help them deliver such care is instrumental to success in value-based care.
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