Value-Based Care: 8 Core Competencies Define a Road Map Forward
The concept of value-based care (VBC) means so much in health care, yet it often means different things to different people or remains unclear. We have witnessed unprecedented health system mergers, increases in physician employment, the rise of health plan conglomerates and the creation of evolutionary partnerships, all largely in search of this elusive “value.”
Some leaders remain skeptical and view VBC as a passing fad, while others have fully embraced delivery system transformation in conjunction with novel payment models. Whether your organization falls into the former or latter category, Sg2 considers improving the health of your population, enhancing patient experience and outcomes, and reducing per capita costs of care to be foundational to VBC, and we have identified key competencies to successfully deliver value, a unifying goal for all health systems.
These 8 competencies help to define a cohesive road map forward.
- Payer, Consumer and Market Dynamics: Successful organizations recognize that the pace of value adoption varies significantly across markets. They know the payer and coverage makeup in their markets, understand Medicare Advantage penetration rates, and keep up with changing consumer deductibles.
- Financial Attributes, Cost and Utilization: When taking on increasing levels of risk, organizations must have the financial wherewithal to face unanticipated shifts in demand, unforeseen expenses and other “shocks.”
- System of CARE: Many factors across the System of CARE must be considered to effectively deliver value—successful organizations are not afraid to approach complicated issues such as service distribution or think outside the walls of the hospital.
- Physician Alignment: “Employment doesn’t equal alignment.” Effective organizations have a robust physician alignment strategy that includes methodologies for employment decisions and a “toolbox” of other alignment models, such as comanagement, professional services agreements and clinically integrated networks.
- Care Model: If there is one area that I would advise clients to prioritize when beginning a VBC strategy, hands down it would be their care model. Often, health systems have different departments handling similar functions (eg, case management, discharge planning, care management, patient navigators). This is one area where organizations never seem to have enough resources.
- Quality, Experience and Outcomes: This core competency is perhaps the most important to delivering value. Success requires careful metric selection and evolution over time.
- Leadership and Governance: Leadership sets the direction for the organization.
- HIT and Data Analytics: Use IT systems to support your VBC strategy, don’t design your VBC strategy around IT systems.
Define Your Road Map to Transform Value
Regardless of how your organization defines the elusive value-based care, delivery systems and payment mechanisms are evolving. Testing new payment models on a small scale is fine for some, but to truly effect change, health care organizations need a defined strategic road map—a plan that sets the direction for the organization, prioritizes areas of opportunity and defines how success will be measured.
Read the full Expert Insight for more details on each competency, as well as a full list of the key Sg2 resources to help set your plan into motion. Not an Sg2 member? Contact us to learn more about how we can help you define a cohesive road map forward with VBC.
Sg2 Member Resources:
- Report: Tracking Markets’ Evolution Toward Value-Based Care
- Report: Service Distribution: Making the Hard Choices
- Report: Physician Alignment: Making the Right Match
- Report: Strategic Partnerships for Tomorrow’s Health Care
Tags: payment models, strategic planning process, value-based care