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July 10, 2018
The Importance of Collaboration in Value-Based Care

The transition to value-based reimbursement, with its emphasis on the entire continuum of care, is bound to lead to some uneasy partnerships among caregivers. But those who forge successful collaborations across specialties and disciplines will be the best positioned to reap the potential benefits of the shift away from fee-for-service models.

Still, the nuts and bolts of collaboration will likely be both new and eye-opening for many. Shawn Purifoy, MD, an independent physician, says he began to completely understand the financial impact of his clinical decisions only after he joined the Aledade Arkansas ACO. Dr. Purifoy, who’s now the collaborative’s medical director, says the insight he’s gained underscores the need not only to collaborate, but to do so in a way that proactively holds fellow providers accountable to embrace best practices, reduce costs, and improve patient experiences.

Pay now, gain later?

Of course, any shift that suddenly transfers responsibility and risk to providers is bound to generate trepidation. And for those who’ve practiced more or less independently for years, the idea of depending on others in a shared-risk scenario is certain to only intensify those concerns.

To succeed in the new paradigm, some may even have to embrace goals and practices that — while improving population health — do so at the potential expense of individuals and organizations, says the National Partnership for the Health Care Safety Net, whose 2017 study outlines both the challenges and lessons learned by two successful ACOs.

Partners have to be committed to shared goals, says the group. Further, they must have a shared mission that mitigates tensions and competition. That’s likely to require extensive discussions and negotiations during decision-making and development, as well as ongoing communication that include frank discussions about the challenges each partner faces. Trust, transparency and equal partnership are the building blocks for success, says the group.

To succeed, they also need EHR interoperability that provides access to real-time data and information, since, as the Commonwealth Fund Commission on a High Performance Health System has noted, fragmentation tends to lead to “poor overall quality of care, and an emphasis on intense, often redundant or unnecessary medical encounters and interventions over higher-value primary care.” Along with tracking the delivery of care, health IT systems need to be able to identify gaps in care and track quality outcomes and cost.

Collaboration with payers

To adapt in the changing world of reimbursement, providers may also have to reassess their relationships with payers, even those with whom they haven’t always seen eye to eye.

With a nod toward the importance of data-sharing and cooperation, insurance giant Aetna has been actively forming value-based partnerships with provider systems to test comprehensive value-based care programs. “As the industry moves away from fee-for-service to a value-based care model, we believe true partnerships between the insurance companies and local health systems are the future, says Genevieve Caruncho-Simpson, chief operating officer for Texas Health Aetna.

Brigitte Nettesheim, Aetna’s president of transformative markets, sees integrated networks and affiliated physicians “as the platform on which to build a value-based offering.” Aetna, she adds, wants to be able to “pay for a variety of services, provided we have joint accountability to monitor and assess outcomes.


Not only does value-based care require an entirely new way of thinking, it also creates a scenario in which information and information-sharing are paramount. CareThrough Navigators can play a crucial role in the transition. They’re trained to update EHRs and bridge the gaps between and among providers, payers and patients.

By identifying at-risk patients, closing gaps in care, and providing ongoing population health management services, they help facilitate collaboration among providers and smooth out the bumpy patches every provider will have to overcome to succeed.

Care Navigators
As healthcare business models evolve, so should care teams.

Patients who are paired with Care Navigators report feeling less anxiety, and an increased ability to self-manage their conditions between visits. And providers report increased job satisfaction from improved efficiency, and knowing their patients have access to care teams, and strategic support.

Chronic Care Management
With an increased aging population managing two or more chronic illnesses, extending your care teams’ ability to communicate with patients is critical. We take a strategic approach to helping patients chart a path towards their health goals, while self-managing their chronic conditions between clinical visits.

AI Chatbots
We deliver a robust AI Chatbot solution to help manage and sustain effective communication with patients. Care teams implement the conversational text messages and customize patient communication to deliver high quality care.

Nurse Care Team Assistants
Adding a qualified Nurse CTA to the care team increases quality of work-life and reduces stress on nurses. The nursing profession is also experiencing an alarming shortage due to increased clerical burdens and burnout.

Revenue Cycle Management
Transition Revenue Cycle Management into the modern age with a suite of software tools that will transform your billing and coding processes. Transact at lightning speed, with increased transparency and decreased siloes. The QueueLogix software application seamlessly integrates with existing EMRs to ensure the clinical activities and back-office operations are well aligned, monitored and successful.

Referral Management
Referrals scheduled by navigators in the clinical setting builds long term, patient care integrity across the care continuum. With the authority, along with the provider to search for specialists in network, navigators assess their schedules, and ensure appointment compliance.

Scribe Services
There’s a reason why we’re the nation’s most frequently used scribe company: we offer professionally trained medical scribes to meet the specific needs of our clients. We offer a variety of scribe programs, as well as technology and personnel solutions that address revenue cycle management, the transition to value-based care, and more through our HealthChannels family of companies.