It’s clear that value-based models are here to stay. Redesigning care can be a significant lift for many healthcare organizations, especially those without existing resources. It’s best to start with identifying the low-hanging fruit: processes that could be improved with automation.
For over a decade, the healthcare industry has been shifting provider reimbursement from fee-for-service to value-based care. Unfortunately, both providers and payers have been plagued by challenges with implementing these new models. As healthcare organizations develop and refine strategies to support the shift to value-based care, it’s important to identify which changes will have the lowest barriers to entry with the greatest yield – or the low hanging fruit.
Technology, specifically digital solutions, is essential for transforming care delivery. Organizations can achieve efficiency and reduce costs by adopting automated platforms that address personalized health to maintain and track clinical performance.
Value-based Payments, By The Numbers
A report from the Health Care Payment Learning & Action Network (HCP-LAN), conducted from May to July 2019, collected data from 70 participants, accounting for nearly 226.5 million Americans, or 77% of the covered U.S. population. The results show progress, with 25.1% of total U.S. healthcare payments in 2018 linked to value and quality and 35.8% tied to bundled payments, shared savings, and other alternative payment models (APMs).
The primary purpose of APMs, under the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP), is to move providers away from fee-for-service to value-based payment mechanisms. The APM model gives provider organizations a CMS-sponsored means to transition towards new ways of delivering care and being paid in a value-based world.
The percentage of APMs across markets was 30.1% for commercial business lines, 53.6% for Medicare Advantage, 40.9% for Medicare fee-for-service, and 23.3% for Medicaid. These results mark an upswing in payments tied to APMs and highlight a continued move away from a fee-for-service system that reimburses only on volume, and towards patient- and value-centered APMs.
It’s clear that value-based models are here to stay, but redesigning care is a significant lift for many organizations, especially those without existing resources. It’s best to start with identifying the low-hanging fruit: processes that could be improved with automation.
When we say automation, we’re talking about using technology to help increase efficiency and scale existing processes and workforce. There are a number of areas where automation can play a huge role in workflow optimization and efficiency, but there are a few we highlight as high-impact:
#1 Data: Collection & Analytics
There is an apparent need across the healthcare industry to effectively collect, digitize and analyze all existing patient data. To date, we have not seen enough efficiency in running data centers, largely a product of manual data collection methods, incomplete patient data sets, and time spent tracking down patients for follow-up (sometimes years later). Data on even a single patient likely lives across different health systems and repositories, with little to no communication or tracking mechanisms.
Automation in data collection and analyzation is a huge opportunity to increase efficiency and reduce waste. With the rise in digital data collection methods that extend outside the care facility, we are seeing patient-generated health data (PGHD) become more meaningful and standardized, thus enabling the advancement of predictive analytics and evidence-based medicine.
#2 Patients: Appointments & Billing
Two significant opportunities for optimization through automation are on each end of the patient visit: 1) their experience walking through the door (for the first time or for unique visits/procedures), and 2) after a visit, via the billing process.
Digital onboarding ensures optimization before a patient walks through the door: automatic feedback loops to administrative and clinical teams can decrease costs by optimizing appointment wait times and aligning covered and received services. Plus, it can increase patient retention, which can be a challenge in today’s healthcare landscape.
Billing departments have seen a high volume of claims that sit in accounts receivable. At times, organizations end up eating costs or continuously bill patients to no avail. This translates to unplanned costs. For example, an analysis conducted by the Advisory Board on over 400,000 patient claims found that a patient’s propensity to pay significantly decreases as deductibles increase, irrespective of income level. A number of digital health companies that automate payment collection and tracking, both at the point-of-service and post-patient visits, prove automation’s ROI almost immediately by reducing the number of unpaid claims without additional effort from care teams and staff.
#3 Clinicians: Workflow & Decision Support
Clinicians are tasked with tracking patient outcomes longitudinally, assuming direct responsibility for their care up to 90 days after a patient has left the facility. Traditional follow-up is manual, leaving clinicians to spend more time on patient outreach and documentation and less time caring for their patients.
Manual care coordination efforts can only be scaled to a certain patient volume before needing additional FTEs. The ROI of clinical workflow automation is tangible and measurable (financially and clinically), and provider and care team satisfaction can increase at a time when clinician burnout is at an all time high.
Providers and care teams can more effectively scale their efforts: time spent contacting patients is decreased, as well as the likelihood that patients fall through the cracks. With clinical decision support tools, patients can receive effective and personalized care pathways and interventions, leading to increased adherence and satisfaction. Additionally, automated monitoring tools help clinicians track the efficacy of various therapies and better understand diseases and available treatment options. By offering care platforms to patients, providers can gain data and insights that would have otherwise been missed.
As health systems develop and further refine their care delivery redesign strategies to support value-based models, it is beneficial to evaluate digital health partners who specialize in targeted areas of care automation. As subject matter experts, these companies have been built on pillars to support healthcare organizations, deliver ROI, and implement standardized metric tracking for continued success that show reduced costs and increased efficiency over time.