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Value-Based Care Model Can Be a Positive for Proactive Providers

In 2017, one of the top trends in healthcare was the value-based care model. It promises to be a top issue in 2018 as well, and the evolutionary impact is great.

“Value-based payment models have the potential to upend traditional patient care and business models,” according to Deloitte.1

Unlike the traditional fee-based payment models in which healthcare providers – including short-term acute care and inpatient rehabilitation facilities – are paid based on the treatment or services provided, the value-based model payment system incentivizes providers based on outcomes.

“Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way,” according to The New England Journal of Medicine’s Catalyst. 2

The evolution to value-based payments makes the goal of a “Triple Aim” health system more attainable. Unlike a fee-based model where no single entity is responsible for a patient’s care, the Triple Aim system requires care providers work together to:3

  • Improve patient care by quality and satisfaction
  • Improve health of patients
  • Reduce cost of healthcare per patient

Why the Need for Value-Based Models?
The cost of healthcare is growing exponentially. By 2020, it is expected to represent $1 of every $5 in the U.S. gross domestic product.4 Because of rising healthcare costs and the aging population, accountable healthcare systems are growing in importance, particularly because of legislation such as the Affordable Care Act, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and related recommendations by Medicare Payment Advisory Committee, among others.

To derive better value, the new model measures outcomes against the cost of delivery. The New England Journal of Medicine’s Catalyst reports that in a value-based model:5

  • Patients spend less money to achieve better health because they receive help to recover more quickly and to avoid chronic diseases.
  • Providers achieve efficiencies because they will spend less time on chronic disease care and more time on prevention-based services.
  • Patients will have greater satisfaction with healthcare as providers focus on value, not volume.

The report concludes: “Even for-profit providers who can generate higher value per episode of care stand to be rewarded under a value-based care model.” 6

The value-based model integrates primary, specialty and acute caregivers into a single delivery model such as a patient-centered medical “home” (PCMH) that is more a digital concentration of patients than a physical location. The PCMH is headed by the primary physician who directs the patient’s clinical care team. All providers in the “home” or team share electronic medical records to ensure proper communication.7

In addition, in a payment-for-value environment, direct admission to an acute inpatient rehabilitation setting for patients with both a medical and functional decline can avert a full and costly hospitalization. It also focuses on functional recovery to return to the community setting and decreases caregiver burden.

More specifically, under the Medicare benefit, the acute inpatient rehabilitation setting does not require a preceding three-day acute inpatient hospital stay to access the rehabilitation services. Alternatively, a skilled nursing setting, where therapy and nursing services are available, does require a three-day acute stay prior to attaining the Medicare-covered benefit.

How to Respond
As the radical shift to a value-based approach evolves, the winning healthcare providers will be the “ones that strategically embrace change starting now to understand the impact and customize the broad array of value-focused shared saving, shared risk and bundled payment models that will work for their individual situations and populations,” according to Deloitte researchers.8

They also suggest healthcare providers who want to sustain growth must construct outcomes-based financial models and develop data infrastructure designed to maximize value-based care. Thus, business integration and data aggregation are essential both inside and outside the providers and across disciplines.

The actionable items for healthcare providers as detailed in Deloitte’s report includes:

  • Transforming coordinated care models,
  • Improving physician engagement and alignment, and
  • Building the technology infrastructure for sophisticated data analytics and financial modeling to manage new clinical and financial risks 9

To accomplish this, organizations will need to integrate their financial, operational, clinical and other data. Doing so will enable them to achieve Triple Aim success – better identification of problems and solutions upstream and outside of acute healthcare; less complex and more coordinated care for patients; and stabilization or reduction of per-capita cost of healthcare.10

How We Can Help
Kindred Hospital Rehabilitation Services (KHRS) works with more than 150 hospital-based programs nationwide to help them strategically and purposefully incorporate value-based models to bring greater success and better patient outcomes to their acute rehabilitation settings.

KHRS also operates 19 free-standing IRFs in partnerships with health systems, with an additional six such facilities opening in the next 12 months. The largest contract manager of hospital-based acute rehabilitation programs in the country, we see over 45,000 patients a year.

At KHRS we take a multidisciplinary approach to our work. We have over 100 medical directors with a national acute rehabilitation Medical Advisory Board; over 180 clinical intake personnel nationwide; over 120 social workers/ discharge planners and over 50,000 therapists – all backed by a national support team.

We provide management services including corporate and field/regional management, billing and coding oversight, 60/40 management, analysis and projects of admission trends, staffing, market analysis, financials, reimbursement expertise, denials management, chart documentation, education and training, and IT solutions.

KHRS is committed to providing a valuable partnership and collaboration that assures regulatory compliance, is committed to clinical quality, optimizes financial performance and is solidly rooted in physician engagement.

To learn more about KHRS, contact us today.


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