Value-based care models are rapidly replacing fee-for-service payments for healthcare services. The most basic definition of VBC is that it ties provider payments to patient outcomes, rather than for services rendered. This model aims to improve quality of care and lower costs.
Another way to look at it is a shift of financial risk from payers to providers. The Centers for Medicare and Medicaid Services (CMS) have proposed many models for transitioning to VBC, as have private payers. VBC contracts typically involve some level of risk and reward. When patients perform better than expected, providers share in the savings. If patients perform worse, the providers may be responsible for costs above those agreed upon or face a decrease in reimbursement.
MIH Services Support VBC
The transition to VBC holds promise for mobile-integrated healthcare teams that are poised to improve patient outcomes and lower costs.
NAMIHP Board of Directors member and Director of the MIH Program at Henry Ford Health, Thomas Derkowski, frequently talks to groups about how MIH supports VBC goals.
“Mobile integrated health provides a bridge of care to the patient,” he said. MIH teams proactively manage patient health, which is key to achieving cost savings in value-based arrangements.
MIH teams can provide this care and support the goals of VBC in three main ways:
- Keep patients out of the emergency department. MIH/community paramedicine teams can assess patients and treat them in place to avoid unnecessary ED visits. That’s easier said than done, but MIH teams across the country have models that support their community’s needs. This may mean partnering with a local hospital, physician organization, or physician offices as well as payers to identify high-risk patients and target them with education. Have MIH teams available to respond and treat in place when possible rather than transporting.
- Avoid or reduce readmissions. Identify ideal patient populations, which may vary by community. Connect patients with MIH services upon discharge to ensure they continue to recover at home. The MIH team can visit the patient, explain discharge instructions, review medication changes and safety, and inspect the home for risks or environmental barriers to recovery. The team can also follow up to make sure the patient is healing. If the patient begins to decline, the MIH team can intervene and offer treatment when appropriate, such as managing diuresis in patients with heart failure.
- Provide longitudinal care. This means visiting patients with chronic conditions regularly in a coordinated program. Diabetes, COPD, and heart failure are frequently the focus of programs like this. However, the specific focus varies by community needs. What conditions lead to the most hospitalizations in your area? MIH teams visit the home and assess the patient, verify they’re following their treatment plans, and help them understand how to stay healthy at home. MIH teams and/or community paramedics can treat the patient at home when appropriate to avoid higher levels of care.
Evidence from individual programs across the country is beginning to show that MIH teams support VBC goals. At Henry Ford Health, Derkowski said in the first full year of operation the MIH team saved the health system $4.8 million in net healthcare costs.
There’s much more to know about value-based care, and the approaches continue to change. MIH teams can play a role in partnering with health systems or accountable care organizations (ACOs) and others to support the goals — and ideally, share in the savings. In the coming months, we’ll take a closer look at other aspects of value-based care. Follow us on LinkedIn to join the conversation.