Value-Based Care: Improving Patient Outcomes Through Care Coordination
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Inefficiency in the U.S. healthcare system continues to be a substantial problem, with as much as 25% of U.S. healthcare spending wasted. There are several factors at play, but failures in care coordination alone account for as much as $78.2 billion of that waste every year.
Waste at such a massive scale negatively impacts all healthcare stakeholders, from providers to patients. That’s why many industry leaders, including Anthem, are working to shift the payment paradigm and advocate for increased adoption of value-based care.
In addition to controlling the cost of care, value-based care focuses on improving patient outcomes with drastic improvements for care coordination between doctors, hospitals, and other providers. Better care coordination means patients (including your employees) receive higher quality, more effective care.
What Is Value-Based Care, And What Role Does Care Coordination Play?
The value-based care model has emerged as an alternative to the traditional fee-for-service model as part of a broader reform effort to improve patient and population health while delivering care at a lower cost. Under the value-based care model, providers are paid for value they provide their patients, not the number of patients they serve. This increases accountability among doctors, hospitals, and healthcare systems.
That’s where care coordination comes in. Under value-based care models, doctors and providers can access patient data across the continuum of care, from lab tests to specialist visits. When all care stakeholders have access to a patient's comprehensive health history — not just the medical issue they're treating at that moment — providers can protect patients’ whole-person health with more personalized and preventive care, and patients can navigate the healthcare system with greater ease.
Here are examples of care coordination activities in action:
- Creating proactive care plans for patients.
- Helping with transitions of care between facilities, such as from a hospital to a rehab center.
- Patient monitoring and follow up to help with any evolving needs or complications.
- Connecting patients with community resources.
- Sharing healthcare information among approved parties.
Research shows that care coordination reduces 30-day readmission rates, and lower admission rates are a strong indicator of higher quality care. While improving patient outcomes through higher quality care is the top priority of the value-based care model, care coordination offers several other advantages, including cost reduction, data loss prevention, and an improved experience across the care continuum.
Overcoming Hurdles To Coordinated Care
Improving care coordination presents significant obstacles for the healthcare industry. Coordination of care processes can be expensive and complex, and many healthcare providers need more talent and infrastructure to implement care coordination at scalable levels.
This problem stems, in part, from the traditional fee-for-service reimbursement model. Fee-for-service systems often lack the infrastructure and incentives for healthcare professionals to effectively coordinate care. A study in the Journal of General Internal Medicine found that only about 35% of primary care doctors’ referrals to specialists resulted in completed appointments. Researchers attributed the low success rate, in part, to complex provider networks and referral scheduling processes.
For collaboration among providers to become routine, the healthcare industry needs to overcome a few challenges, including:
- A lack of interconnectivity between electronic health record systems from different vendors.
- Resistance from other healthcare organizations to adopt patient care coordination processes.
- Patient opposition to working with a care coordinator, nurse, or other providers to manage their care interactions.
Significant progress continues to be made. Technologies such as electronic health records have helped automate some care coordination communication paths. Likewise, innovative partnerships between entities across the care continuum, such as our partnership with health information company Epic, can help bridge communications between providers and health plans on a massive scale.
As more healthcare stakeholders become aware of the importance of supporting whole-person health at the system level, value-based care models will grow in implementation and adoption. In turn, the benefits of solutions that anticipate the needs of doctors and patients will only increase.
This shift toward patient-centered care opens up an opportunity for employers and other organizations to better support their employees through innovative, tech-enabled health plans that use integrated digital solutions to provide simpler, more streamlined care experiences.