While traditional fee-for-service reimbursement models still dominate the healthcare industry, there has been a significant increase in the adoption of value-based care (VBC) models by healthcare organizations. Between 2019 and 2021, investment in VBC and alternative payment models grew by an impressive 400%, while investment in legacy care delivery models remained stagnant. This shift towards VBC is driven by healthcare leaders aiming to reduce costs while enhancing patient care and improving outcome quality. However, transitioning to VBC is not without its challenges.
Chad Dodd, the Vice President of Product Management at athenahealth, recently spoke with Becker’s Healthcare to shed light on why organizations must prepare themselves for the shift to VBC. Dodd emphasized that many healthcare providers struggle to pursue alternatives to fee-for-service due to the complexity and ever-evolving nature of VBC payment models and regulations. Limited resources further compound the difficulties faced by healthcare practices in adapting to value-based care.
Despite these challenges, Dodd stressed the importance of understanding that the shift toward VBC models is an ongoing and fundamental trend in the healthcare industry. Each year, fee-for-service dollars are progressively being replaced by VBC reimbursements. Dodd cautioned that failing to recognize and adapt to this payment landscape shift could render healthcare practices financially nonviable in the long run.
One crucial factor enabling the success of VBC is the availability of contextualized patient data at the point of care. This means that healthcare providers must have access to comprehensive and relevant information about a patient’s health history. However, healthcare information often remains fragmented and challenging to access across multiple care settings and payers. Dodd highlighted that athenahealth’s network addresses this issue by allowing clinical and financial data to flow seamlessly between various healthcare entities, such as electronic health records, registries, labs, pharmacies, and payers. This comprehensive patient data helps practices provide optimal care, regardless of the payment model they employ.
In addition to facilitating access to patient data, athenahealth’s technology simplifies healthcare by providing critical insights directly at the point of care. It eliminates the need for providers to navigate multiple systems to access patient records or identify gaps in care, allowing them to focus their time and attention on patients themselves.
Moreover, athenahealth extends its support to healthcare practices through chronic care management services, enabling them to reach out to patients in new ways and improve outcomes. As healthcare organizations of all sizes transition to VBC models, athenahealth’s software and services play a vital role in facilitating a smooth implementation process and driving desired outcomes.
To succeed with VBC, athenahealth has identified five key foundational capabilities based on its extensive experience working with hundreds of thousands of providers. These capabilities encompass areas such as data management, operations, behavior change, and resource allocation. By leveraging these capabilities, practices can navigate the challenges and reap the rewards of value-based care.
Overall, athenahealth aims to assist healthcare practices in their transition to VBC, ensuring their viability in the community and empowering them to provide the best possible patient care. Dodd emphasized that the shift to value-based care is a story that applies to both large health systems and small physician-led practices. athenahealth strives to support all sides of the spectrum and help healthcare providers navigate the evolving landscape of fee-for-service and value-based care.
With over 90% of eligible network clinicians achieving exceptional performance in the Merit-Based Incentive Payment System (MIPS) in 2021, athenahealth’s track record speaks to the effectiveness of its tools and capabilities. One success story highlighted by Dodd involves Carolina Regional Orthopaedics, based in Rocky Mount, N.C. By leveraging athenahealth’s solutions, they achieved exceptional MIPS performance with final scores reaching 100 or higher.
As the healthcare industry continues to embrace value-based care, healthcare providers need to be equipped with the necessary capabilities and technologies to succeed in this evolving landscape. athenahealth is committed to supporting the transition and enabling healthcare organizations to thrive in the shift towards value-based care, ultimately delivering better patient outcomes while reducing costs.
