Rapid Adaptation: How the Coronavirus Crisis is Validating Value-Based Care

As the number of COVID-19 cases rises, the healthcare system continues to face new challenges. Along with PPE, ventilator, and bed shortages, the financial burden placed upon the healthcare system continues to escalate. In a recent report published by Strata Decision, hospitals will lose an estimated average of $2,800 per COVID-19 case. When compounded with the cancellation of more lucrative elective surgeries and the closure of many ancillary services, providers are left facing an uncertain financial future.

To combat this challenge, providers will seek alternative organizational and financial operations. A shift to value-based care, which has steadily increased over the past decade, is an approach to patient care likely to increase following the pandemic. Using predictive modeling, care coordination and patient engagement platforms, value-based care has proven to be a successful strategy to improve patient outcomes and reduce overall healthcare spend.

By working at the intersection of patient care and population health, value-based care strategies have continued to redefine patient care. When deployed, the following strategies of value-based care models can enable providers, patients, and payers to adjust to a new normal.

Care Coordination

Through participation in accountable care organizations (ACOs), healthcare providers can work collaboratively and reduce repetition of services, resulting in improved care and spend reduction for patients and payers. The Center for Medicare and Medicaid Services (CMS), provides financial incentives to ACOs based on their ability to reduce overall cost of care.

Since the COVID-19 pandemic poses a significantly higher risk to older adults, ACOs partnering with CMS are concerned that the unforeseen increase in spend associated with COVID-19 may cause a severe financial burden. Although CMS has made policy adjustments in response to COVID-19, the financial impact on ACOs remains unclear.

However, participation in ACOs provides a steady cash flow, as providers are paid set rates on a monthly basis for patient care.  This payment structure offers significant advantages to providers, by reducing cash flow problems during future crises, and enabling providers to develop stronger financial plans going forward.

Analytics & Technology

Analytic and technology platforms enable value-based care providers to collaborate effectively, predict population health trends and engage patients. Technology platforms like electronic health records (EHRs) and health information exchanges (HIEs) facilitate real-time sharing of patient clinical and financial data. In conjunction with complimentary population health management platforms, which provide risk assessment tools and insight into the social determinants of health, providers can better predict patient risks and care requirements.

Understanding the analytics behind population health and increasing coordinated care efforts has been essential in the fight against COVID-19.  Value-based care has consistently deployed population health and coordinated care efforts, which have been impactful in crisis management and will continue to be in post-COVID patient care.

Cost Containment 

Reduction in overall healthcare spend is a driving factor in the shift to value-based care strategies. Using accountable care organizations and healthcare technology platforms, value-based care providers can assess financial risk, provide preventative care services and engage high risk populations. The result, a lower rate of hospital admissions, improved access and use of preventative care and a reduction in overall spend.

As the story of value-based care in the US continues to be written, the pandemic seems likely to leave a legacy of validating its vitality. COVID-19 has placed a tremendous financial burden on healthcare providers, payers and patients. Value-based care strategies coupled with growing advancements in healthcare technology better equip providers for a post-COVID era.

Health Care Practice