This article is the forth in a multiple-part series exploring the intricacies of value-based care in the U.S. healthcare system.
Because it is not how many times you get knocked down, but how many times you get up that counts, we have added this bonus fifth article is our multiple-part series exploring the intricacies of value-based care in the U.S. healthcare system.
Implementing Value-Based Care (VBC) is a complex process that requires careful planning, collaboration, and investment. However, there are several common pitfalls that can lead to failure. Here are some key factors that can derail your efforts.
Untrained Sales TeamIf you are a group selling VBC or even if you are attempting to rally support for VBC internally to your own group, a unique approach is needed compared to traditional sales efforts. It involves a deep understanding of the healthcare landscape, patient-focused care, and specific billing practices allowed under VBC programs. Sales professionals must be well-versed in various billing codes, reimbursement models, and compliance requirements to effectively communicate the financial benefits to potential clients. Additionally, they need to demonstrate an understanding of care coordination, preventive care, and chronic disease management to build trust with providers. By providing case studies, data, and real-world examples, sales professionals can inspire confidence in VBC programs and highlight their value.
A common issue specific to VBC groups is the failure of salespeople to effectively transition clients to the implementation and account management teams after program launch. This can lead to confusion, miscommunication, and a lack of continuity in the implementation process. To avoid this, establish clear protocols for handover and ensure that sales and implementation teams work closely together. The skills needed to show the value of VBC, and the skills needed to successfully implement and run a VBC program are distinct and different.
One of the biggest challenges in implementing VBC is getting providers on board. Without their buy-in, the initiative is doomed to fail. Providers may resist change due to concerns about increased workload, financial risks, or a lack of understanding of the new model. To overcome this, it is crucial to engage providers early in the process, provide adequate training, and address their concerns.
It is difficult to meet a provider that is looking for more things to do in a day and making time for a new process is difficult. This is where leveraging advanced algorithms, predictive models, AI, and other technology is critical. To this end, if a program must wait for a busy provider to review and approve each and every identified patient before care managers are allowed to engage, it will be difficult to achieve critical mass. This can lead to inefficiencies and distract providers from their primary responsibilities of delivering high-quality care. By striking the right balance between provider involvement and technological support, organizations can streamline the patient identification process and enhance the overall effectiveness of VBC initiatives.
Implementing VBC requires significant investment in technology, training, and infrastructure. Without adequate funding, it is impossible to achieve the desired outcomes. Organizations must be willing to invest in the necessary resources to support the transition to VBC. This includes investing in advanced data analytics tools, comprehensive training programs for staff, and robust infrastructure to support new care models. Additionally, securing ongoing financial support is crucial to sustain the initiatives and ensure continuous improvement.
Having an experienced technical team is crucial for the successful implementation of VBC. Technology is a vast area with various specializations. The group that is supporting email and laptops has a different skillset than the team that will design, implement, support, and/or develop VBC software. The proper team plays a vital role in integrating advanced data analytics tools, developing robust infrastructure, and ensuring seamless interoperability between different systems. Their expertise in handling complex healthcare data and technology is essential for identifying suitable patients, tracking outcomes, and optimizing care delivery. Moreover, an experienced technical team can troubleshoot issues quickly, adapt to evolving requirements, and provide continuous support to healthcare providers.
In conclusion, successfully implementing VBC requires a strategic approach that addresses common pitfalls such as lack of provider adoption, inadequate investment, mis-matched technology teams, and ineffective sales transitions. By leveraging technology, investing in necessary resources, and fostering collaboration among all stakeholders, organizations can overcome these challenges. Ultimately, a well-executed VBC initiative will lead to improved patient outcomes and significant cost savings.
Patrick Kelly is the President and CEO of 4th Season Consulting. With over 20 years of experience in value-based medicine, population health, and care management, Patrick has led numerous successful initiatives in the healthcare industry. His expertise spans various roles, including CIO/CTO at Phytel, Loopback Analytics, and MPOWER Health, as well as Vice President of Information Systems at Catalyst Health Group.
4th Season Consulting specializes in the unique needs of the healthcare industry by providing a wide range of consulting services including business intelligence, custom development, IT support, cloud infrastructure, HIPAA and compliance consulting, and digital marketing. The 4thSeason Consulting team brings a depth of expertise tailored to the unique needs of healthcare providers, from solo practitioners to large organizations. All without contract minimums or long-term obligations.
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