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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. ScribeAmerica 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.