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How Technology Helps with Transition to Value-Based Care


Physicians may have heard value-based care programs will gain traction over the next five years, but are they ready for it?

Physicians may have heard value-based care programs will gain traction over the next five years - but are they ready for it?

If you believe a newly released report from health information network provider Availity, "Provider Readiness to Support Value-Based Payment Models," the answer is no, not really.

Currently, only a small percentage of providers and plans have fully-automated information exchange programs in place, which experts believe will be required by physicians and payers for the transition to value-based care. The study, based on interviews with 39 healthcare plans and 50 healthcare providers from hospitals and practices, revealed the high potential for market disruption unless all parties do more to prepare themselves for the change.

"In today's fee-for-service world, the payments are typically done for a discrete unit of service [such as] an office visit, a procedure, a test, etcetera," Ryan Miller, senior vice president of strategy and corporate development for Availity, told Physicians Practice. "It's a more straightforward nature of the payment. As you move to these value-based programs, the payment now is covering either a bundle of services over an episode, or it could be covering the entire treatment of the patient over a given period of time, typically year of service. The breadth of what the payments are covering and the number of participants involved are more complex and more robust than today's fee-for-service world."

Russ Thomas, Availity CEO, told Physicians Practice that participating in value-based initiatives such as Accountable Care Organizations means thinking about patients and disease management in a more holistic way.

"You're really talking about a cultural evolution in the way medicine is being paid for," said Thomas. "For many, many years, physicians have been indoctrinated into a 'fee for service' world. The entire physician work flow has to change in order for this to be successful."

To help minimize disruptions at physician practices in making the transition to value-based payments, Miller and Thomas made a few suggestions.   

The first: Use technology that allows for time access to a richer set of information, such as provider portals.

"There are a number of things we do already and can increasingly do on the [provider] portal as interim solutions until we as an industry get to full interoperability," says Miller.

Another method of minimizing disruption: Automating revenue cycle management processes. For some practices, this may mean investing in new RCM technology.

"Existing systems have evolved to mirror today’s workflows for things like patient check-in and remittance routing for providers, and adjudication and payment administration on the payer side," said Miller. "As we look at new payment models such as bundled payments, there are likely to be new work flows that need to span multiple providers - with each provider's quality metrics affecting their share of the bundled amount. No systems exist to handle scenarios like these, and as stop-gap, people are left trying to adapt current systems which were never built for that purpose. New RCM technologies will need to keep pace with these changes, and will require investments by both providers and payers."


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