How Culture Change Reflects the Realities of Value-Based Payment

Value-based payment programs have transformed the provider culture. In some cases, these culture changes have been monumental and in others there is small, incremental change.

Creating a bundled payment program, for instance, not only influences culture in the way organizations and clinicians think about and structure themselves to manage care, but also positions providers to work with employers, reduce costs in their own employee health plans, and work with payers.

Not long ago, providers lacked true line of sight into a patient’s post-acute care after leaving the acute care setting.

But with the value-based payment movement, providers are creating bundles that focus on care coordination improvement activities for three months or more after a patient is discharged. This has made physician leaders much more interested in where patients go after discharge from the acute care facility and understanding why a patient went out-of-network to seek care.

Clinicians did not always have insight into the “why” or “for how long” a patient was placed into a specific post-acute location. They did not always know how their post-acute utilization compared to others across the country and how post-acute decisions impact overall savings outcomes in a bundle payment program. The idea of waiting to schedule an elective surgery until a patient was “optimized” (e.g. the patient needs to lose weight or regulate his/her A1C level), was certainly done, but not always a standard of care for pre-surgical preparation.

The value-based care movement has brought great change to the culture of healthcare and its operations.

Value-based care and payment models require health system leaders, clinicians and other frontline staff to embrace a whole new perspective on delivering high-value care. This new perspective centers around transparency, shared accountability and collaboration – principles that often fell to the wayside in the traditional fee-for-service model.

No longer is readmission prevention just an acute care concern. It’s now a common quality measure to incent specialists and hospitalists, as well as a common agenda item in physician steering committee meetings where bundled payment data and metrics are shared across physician groups and individual physicians.

So much work has been done to optimize bundled payments through CMS models (such as the Bundled Payments for Care Improvement Advanced Model), and some organizations are now building on that work to create shadow bundles as part of their clinically integrated networks, accountable care organizations, and commercial and/or direct-to-employer strategies.

New concepts like shadow bundles are igniting conversations at the physician stakeholder level where specialists want to improve care processes and practice patterns. Providers are using claims data to see who and how an entity and/or individual practice/practitioners can contribute to savings and where that savings would come from. They want to design episodes that impact the total cost of care, and that reflect clinical practice based on guidelines and science. For example, some Premier members are measuring the use of hospice and palliative care for patients with a chronic condition as well as taking steps to understand the impact of beneficiary engagement and other factors such as selected medication, use on admission and readmission rates.

While these steps forward have been in motion over the last decade, they’re becoming pro forma.

It’s important we take a moment to reflect on the new culture we’ve formed and are nurturing across the industry. Healthcare is changing for the better, little by little, one episode at a time.

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