The U.S. healthcare system was caught ill prepared for a worldwide pandemic. The health system, which has been moving slowly but surely towards value-based care and other alternative payment models for the last decade, had to realign priorities to from primary care to acute care services. If COVID-19 has taught us one thing, it is that the fee-for-service payment model has not been resilient or flexible addressing the primary care needs and preventive health challenges created by the pandemic.
The need to transition to value-base care is more urgent than ever. The pandemic caused a delay in elective procedures and has create a significant level of unmet needs going into 2021. For most payers this has illuminated the need to accelerate the adoption of more value-based care to help managed care deferred because of the pandemics.
Community health centers, as with other primary care providers in Arizona, found themselves ill prepared for the clinical and social determinants of health impact of the Covid-19 pandemic. Health centers found themselves unable to maintain service levels as communities were under stay at home ordered, and staff themselves succumb to the Covid-19 virus. The normally high performing health centers had significantly reduced service capacity. Women and children’s well care and preventive care services were the first casualties of the health center’s reduced capacity. Additionally, health centers’ historic outreach and health education activities in the community were severely curtailed, leaving many communities without a trusted source of health education information about the Covid-19 virus and preventative measures critical to avoiding infection.
Covid-19 also impacted health center FFS revenues, which has reduced the health center’s available funding for investment in necessary value-based infrastructure and staff development and training. The overhang of the Covid-19 pandemic continues into 2021 as vaccines where slow to roll out in some Arizona communities and the difficulty health centers have faced overcoming misconceptions and misinformation about Covid-19 and the vaccine that has spread in vulnerable high-risk communities. Health centers have also had to use existing staff resources for providing Covid-19 vaccinations that would normally been available to address women and children well care and preventive services.
Community Health Centers have been involved with value-based care for the last five years. recent months, however, the most of the focus of health centers has been to improve quality performance and have to the most part neglected the management of cost and service utilization.
Even community health center quality performance has shown mixed results which has reduced value-based payment and tempered some health center interest in participating in risk-based value-based payment models. The role of VBCare Network is to make meaningful systematic changes in the FQHC value-based performance capabilities, especially in the area of their capability managing quality and cost performance.
Some community health centers have failed to produce meaningful savings or improved outcomes or have taken too long to make the changes necessary for success in value-based care. Others have not addressed their organization culture or data infrastructure necessary to compete as an individual health center is value-based care. Individual FQHC may have a challenge achieving a large enough base of attributed health members achieve adequate scale. This is why VBCare Network was created to support community health centers with these and other challenges.
Broad adoption of value-based payment arrangement has been slowed among community health centers due to the following challenges:
- Serving an aging and more vulnerable population who often have significant chronic illnesses and behavioral health needs.
- The continuing impact of the Covid-19 pandemic on service utilization and its overhang effect into 2021.
- The need for more timely quality and cost data to better manage high-risk populations.
- Delivery system consolidation that has changed the competitive equilibrium of healthcare network contracting and service pricing.
- Continuing challenges of the integration and optimization of electronic healthcare records and clinical decision support tools.
- Data Exchange and Data Management Challenges
Processing data files and the transformation and ongoing enhancement of data to harvest performance insight and use information effectively in performance improvement actions. VBCare Network value to our member health centers is that we provide the data platform and data analytics to make their performance reports timely and actionable.
- Organizational Cultural and Clinical Care Management Change Challenges
Beyond information technology, the value-based care delivery requires a culture of continuous performance improvement and formal change management processes in that are foreign to clinical staff who have practiced under an FFS payment model, which is based on service transaction volume and not on the ultimate improvement in the health outcomes of patients. VBCare Network works with participating community health centers to align their organization quality and care management and clinical staff to value-based care. VBCare Network provides on staff training and continuous performance improvement support to health centers to has led to improve results.
- Electronic Data Use and Optimization Challenges
Community health centers, because of the impact of Covid-19 on revues have not had the funds to invest in developing value-based care and clinical decision tools that are so important to value-based performance success. VBCare Network overlays our data management, data analytic infrastructure, and data science expertise to support the health center’s continuing deployment, integration, and optimization of patient health information, performance analytics, and clinical decision support tools.
Success of the next-generation of alternative payment strategies, will require VBCare Network to transform multiple data sources and data types into useable value-based intelligence, which will require VBCare Network to provide a new set of strategic approaches, clinical care models, and performance improvement methodologies for it participating health center who provide care to the most vulnerable Arizona populations and communities.
VBCare Network reduces the health center’s administrative burden of participating in multi-payer value-based care arrangements. This includes contracting and normalizing health plan data and performance reports into a single network performance requirement instead of individual value-based contract requirements for each health plan or payer. VBCare Network also collaborates with health plans and payers to collaborate on payer specific improvement initiatives.
Actionable performance data and intelligence has been a challenge for community health centers. VBCare Network aligns model of care to value-based performance and quality and cost performance measurement to achieve year over year financial success. VBCare Network provide its participating health centers a more complete view of their care gaps, patient care continuum, and visibility into the need of their high-risk high-needs patients assigned by health plans.
The bottom-line is VBCare Network provides more comprehensive data and actionable information, value-based business intelligence, reduced administrative burden, and continuous improvement support that creates the best opportunity for community health center to succeed in value-based care.