The COVID-19 pandemic was an epic stress test for the healthcare system in general, and it affected performance across the board in regard to value-based practice. Everything went in the wrong direction: inpatient numbers ticked up; quality suffered; wellness suffered — children did not get preventive-type care or immunizations, and people delayed cancer screenings. But it also catapulted the healthcare system forward with an ability to deliver on value-based care in several ways:
- Telemedicine became a permanent tool in a practice’s toolbox
- Remote patient monitoring is more widely available and a part of care delivery
- AMA medical updates for coding and documentation guidelines improved
Healthcare practitioners learned to be flexible and perceived the need to create a quality dashboard that contains what the quality measure should be, how to adjust the measure for things like pandemics and how to make adjustments on the fly to understand, Where is quality and how is it happening?
Deferred care — often due to lost healthcare coverage because of job loss and a fear of contracting the virus in a healthcare setting — was rampant and posed serious implications. As a result, providers reported seeing sicker patients. In the long run, preventable diseases may increase and a backlog in care awaits down the road. The bottom line is the healthcare system must gear up to handle all of these deferred-care consequences effectively and efficiently.
Care Delivery Changed by the Pandemic
Have you seen your own primary care provider in office during the last 8 months?
The evolving changes caused by the pandemic may become the springboard to successfully handling healthcare issues stemming from upcoming spikes in COVID-19 cases to handling the expected surge of patients who resume healthcare after putting it on hold. This may require healthcare delivery to evolve into a hybrid of different platforms such as home-based testing, point-of-care testing, more preventive care, more outbound mobile centers and community-based centers, and community health workers to connect with people who are hard to reach (the vulnerable population) and engage them to bring them into the care system.
The rise of telehealth showed a change in consumer preference for convenience: We want care where we are and when we need it. But transitioning to tech interaction has its difficulties.
Someone’s 80-year-old parents may have trouble accepting it, and the low-income-level underserved have an innate desire to have face-to-face visits because of high-touch trusted relationships. For each of those examples, a relationship with a trusted provider is critical. Balance is the key.
The challenge on the provider side is to transition from being the sole source of care delivery to one who manages the health of their flock (patient panel). Such a transition requires technology and tools. Care must be managed to make sure that proper preventive services and ongoing chronic care still happen and yet obtain outcomes that will drive the results for the health system.
The Value-Based Footprint in a Post-COVID World
In the wake of COVID-19, health plans can now better understand how the entire health system works best around fast-acting technology and measurement systems. The pandemic exploded the idea of using data from different systems and places for everything from operational activities to looking more on the patient experiencing health outcomes that needed to change. It accelerated and emphasized the need for communication in a way never before experienced.
Healthcare is a team sport. In order to make it all work, different aspects and players of the ecosystem have to have a singular view of the patient during their journey into the healthcare system. Interoperability is key to that.
The pandemic raised significant interest in many value-based providers in recognizing the value of having up-and-downside risk and a more capitated global payment to protect against downside. Value-based care puts focus on what is necessary and needed for the patient and puts payer and providers on the same side.
On the other hand, the pandemic accelerated the need to address questions that have always lingered: What is the roll of the plan, the role of providers and the shared rolls that will move healthcare into the ideal direction? And it showed a need to re-evaluate how to value and reward care and how to deliver care more effectively to improve the health of the population for all, not just some. The healthcare industry needs to rethink how to measure quality and outcomes in programs that will propel it beyond historical payment models.
Supporting the Value-Based Programs and Providers
Practice Transformation has been in the healthcare lexicon for decades. It’s not called Provider Transformation; it is team, was team and always will be team. From the receptionist in the front of the office to the medical assistant and clinician in the back of the office, and now community health workers who are out in the field connecting with patients. If everyone has access to the information that is needed to move forward, that’s a big win. On the care delivery side, any type of caregiver needs insight. They can practice medicine if they have a problem list, a medication list, some labs and an idea of what the gaps care are from a prevention perspective. They can piece a lot together with information related to everyone who’s had an encounter with their patient.
Managed Care Partners on the Rise
What has been your plan to expand the performance against value-based care contracts?
Interesting bell-curve normality curve here, when you look at poor and excellent being equal and the peaking of average and good. Not surprising. Wish it were more in the upper end of the curve.
In order to be profitable, a provider has to see a patient every six to nine minutes. But on any given day, the practicing clinician is overwhelmed to keep up with all the moving parts and who’s interacting with their patient. There is a great need for skills, capabilities and work flow infrastructure for population health. Providers are partnering with other firms or organizations to help manage their program so they can focus on patient care.
The pandemic has been very stressful for the smaller provider size. The opportunity for independent groups in networks and smaller practices to tie their raft to bigger organizations not only allows them to focus on the patient care — which is really what they want to do — but it supports them with tools and technology to relieve some of the burden of trying to be successful and providing a financial path.
The holy grail is member self-management — the patient taking more ownership of their health. When the patient can contribute their own information to the medical health record and actually see engagement and behavior change, that’s the holy grail.
About Equality Health
Equality Health, LLC is a Phoenix-based whole-health delivery system focused on transforming value-based care delivery with population specific programs that improve access, quality and member trust. Through an integrated technology and services platform, a culturally competent provider network and a personalized care model, Equality Health helps managed care plans and health systems improve outcomes for diverse populations while simultaneously making the transition to risk-based accountability. For more information about Equality Health, visit equalityhealth.com.