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Focus on Outcomes: Moving to Value-Based Health Care

Tags: Health

Healthcare is an ever-changing landscape. When looking at providing public funded services for behavioral health and other human and social services, the needs have grown rapidly over the last two decades. Particularly in public sector, care professionals are focusing on treating the whole person, and as value-based models continue to expand, the emphasis on collecting and sharing authorized health information among a person’s care providers is even more vital.

Data shows that there is a growing population that is experiencing co-occurring health issues. Co-occurring conditions can range from mental illness like depression, anxiety, or drug addiction in addition to a physical health condition like asthma, diabetes or heart disease. In fact, 50 percent of persons with severe mental illness suffer from two or more co-occurring chronic medical conditions.

In many states, County organizations are often the front door for people with these co-occurring health issues, and often the only resource available for individuals to seek treatment for their health needs. This makes those counties the critical link in providing resources and assistance to a person in need. We see this not just in physical and mental illness, but also in social factors related to health, like addiction disorders, employment and homelessness.

The success of recovery depends on an action plan that treats all of a person’s issues concurrently. Wellness cannot be achieved if we are not looking at the bigger picture and focusing on the outcomes of the person. By having electronic health record systems in place, hospitals and post-acute systems can exchange data about a person’s broader health history, empowering providers with the information needed to recommend the most appropriate treatment.

Outside of specific waiver programs, Counties have traditionally used a fee-for-service (FFS) model for billing.  Put simply, FFS billing is based on procedures done and services received, not on outcomes of the care.  The high volume of individuals coming through the doors can lead to shorter time spent with clinicians and other care professionals, which often leads to not having enough time to understand the whole picture fully.

The emerging payment model focuses on the value of the overall care (cost efficiencies) as it measures the outcomes of that care (quality being provided). This is called a Value-Based Care (VBC) payment model.  It allows for care providers and organizations to provide and measure care in a cost-effective way.  It requires that the “whole person” be treated. Instead of ordering more tests and services which might not be necessary, clinicians and other members of the care team will be required to carefully plan the best approach for the person’s care and resulting outcomes.

Many counties and healthcare organizations are still using this FFS model. The ability to transition to a VBC model for the individuals they serve is a critical step in addressing the growth in need with the available dollars. The success in VBC delivery will be evaluated, measured and compensated based on measured outcomes and improvements in the person’s health.

How to prepare for the switch to VBC?

  • View VBC as a strategic priority for the agencies in your county. Look across your service providers, from corrections to behavioral health to foster care to public health and establish a continuum of care with technology to support integrated data sharing and analytics to measure success.
  • Enable a person’s health information to follow them across the continuum of services and healthcare organizations. By doing this, you can transition information, care planning and services between various departments.
  • Get everyone onboard for this transition to VBC. Be sure to engage all stakeholders – elected leadership, executive, financial, operational and clinical collaboratively in the initiative.

The future of publicly funded healthcare services will be through a VBC model.  The trend to a VBC model is growing for individuals and providers alike. To provide the most value with the limited dollars available, it is even more important for county organizations to shift towards VBC.  Is your organization ready to make the switch?

Be sure to visit the Netsmart booth at NACo's 82nd Annual Conference & Exposition, July 21 – July 24, 2017, to learn more about how Netsmart can help you succeed in a VBC environment. 

Learn more about value-based care with Netsmart’s Value-based Care webinar.