A value-based care approach can be applied to all aspects of health care, regardless of specialty. When we focus on the quality of care rather than quantity of services provided, physicians, patients, and payers all benefit from the shared savings.
Independent physicians are well positioned to succeed in payment models that reward Value.
Consolidation leads to a lack of market competition, which drives pricing based on scale rather than value. With strong quality of care, competitive costs, and increased access to care, independent physicians are well poised to deliver and win under models that reward value (cost + quality). It is not an easy transition, though, as these models require independent practices to collect and analyze their data, redesign care processes, and mobilize capital for risk. Three key challenges for physicians’ participation in value-based care are:
Participating in value-based care opportunities: There are limited opportunities for specialists today. The few models that do exist tend to be for proceduralists. The health care system has found it challenging to put operational parameters around chronic care management.
Using data to inform quality improvement initiatives: Independent specialist practices, which range from one physician to 90, do not have the financial and management resources in-house to tackle this specific set of analytic needs.
Affordability of participation: Value-based care requires significant investment in technology, analytics, and care redesign. Additionally, risk contracts often require financial reserves that exceed the typical capitalization levels of independents.
Our aim at TMA Specialty Services is to help independent specialists tackle these challenges through our utility technology platform and advisory services.
Value-based care leads to more efficient health care for patients.
A common complaint about health care is its siloed nature. For instance, specialists generally focus only on their area of expertise, and disparate technology systems for referrals, care documents, and results have only furthered this challenge. Value-based care encourages a holistic view of the patient—ACOs are responsible for total costs of care, while specialists are responsible for managing an episode of care. For the first time, specialists are being asked to consider post-acute care, a patient’s comorbidities, and unplanned events. TMA Specialty Services uncovers the data that supports these initiatives. For patients, this means more efficient healthcare. Their physicians need to communicate to achieve winning outcomes. This longitudinal view of a patient’s experience tends to lower costs, reduce unnecessary care, and improve outcomes.
For Health Plans
Health plans and physicians work together to lower total cost of care for their patients.
The alignment between payers and providers has been built upon lowering the total cost of care for an attributed patient population and then sharing savings. The lower-cost incentives are especially aligned for payers and independents who have a typically lower cost structure; however, it has been difficult for health plans to engage specialists in value-based care due to a number of challenges including:
The difficulty of attributing a patient’s cost to a specific specialist
Inability of existing claims systems to support team-based care models
The absence of comprehensive federally driven payment innovations for specialists such as ACOs and Medicare Advantage plans
Health plans empowered primary care physicians by sharing cost data on their attributed patient populations. Recognizing the need for health plans to share data with specialists in an aligned, appropriate value-based care context, TMA Specialty Services has developed a scalable technology platform for this purpose. As a result, independent specialists are becoming empowered with their own unique data and analytics, independent specialists identify variations in cost and quality within their group or bench marking community and implement quality improvement processes.
TMA Specialty Services actively supports national efforts to standardize value-based care payment innovations in both procedure- and condition-based episodes of care by leveraging current claims systems. We are a leader in establishing public and private initiatives that incorporate a longitudinal view of a patient’s experience and team-based care involving both specialty and primary care physicians.
While value-based care’s marquee changes involve payment models, care redesign, and care coordination, the need for data and analytics to drive value-based models has had positive downstream impacts; data, like the various physicians a patient sees,
In version 1.0 of value-based care, primary care physicians have been engaged by the health care system to improve population health and reduce the total cost of care.
To fulfill the objectives of value-based care, version 2.0 is now emerging. Specialists can participate by improving outcomes and increasing efficiency by management of bundles or episodes of care. By focusing on improving value in their specialty, specialists complement rather than duplicate primary care-driven care coordination efforts. And in working together with primary care physicians, all participants should be rewarded for the value they create for patients and the health care system.
Specialists utilizing TMA Specialty Services have a custom analytic platform to help them identify and drive out low value care, deliver earlier interventions in chronically ill patient populations, manage unplanned events, and support appropriate inpatient and post-acute utilization.