How to Implement Value-Based Care as an Independent Practice

Wondering how to implement value based care as an independent practice? Read on to learn why and how independent practices can implement VBC, or contact the team at CIPA+ for help making the shift to value-based care.

Slowly but surely, the past few years have seen a sea change in healthcare: the shift toward value-based care. Also known as the shift from fee-for-service to fee-for-value models, this industry-wide change is the result of payers, providers, and government entities all moving toward a model which places an increased emphasis on quality and patient outcomes.  

Before, in a fee-for-service model, reimbursement was based on the negotiated fee schedule and volume of care provided with no incentives to focus on quality. Whereas value-based care (or VBC) models still pay for services rendered but also offer reimbursement for monitoring, following, and improving outcomes based on a standard quality of care metrics. In other words, the shift to value-based care is all about shifting spend to focus on providers who proactively manage patient care with preventative treatments – thereby reducing costs to the healthcare system and improving patient outcomes. 

Are you searching for how to implement value-based care in your practice or operation? You’re not alone. The introduction of value-based care models was already well underway prior to the COVID-19 pandemic, and the shortcomings of the fee-for-service model – illustrated by the pandemic – has only served to accelerate value-based care’s adoption value-based care’s adoption. 

In principle, value-based care sounds like a win for all stakeholders – but why should independent practices, in particular, implement value-based care and where can they start? Furthermore, how can organizations that have implemented value-based care measure their success? 

Why Should Independent Medical Practices Implement Value-Based Care? 

Making the switch to value-based care can be an intimidating prospect for independent medical practices. Some practices believe that adopting new strategies both clinically and operationally for value-based care ultimately means less revenue for the practices.  Understandably so, as value-based care is indeed a new financial business model. In addition, it also requires a more robust data IT system since reimbursement is tied to patient outcomes – and consequently, data and metrics tracking those outcomes become more necessary. 

Taken together, for independent practices that may be lacking the resources of a larger group, these factors can make the shift seem daunting at first. But the fact of the matter is that value-based care is not only within reach for independent medical practices – it’s happening regardless of whether or not physicians embrace the concept. For a lot of physicians, value-based care feels intangible.  It’s changing regularly, and staying up to date on concepts and regulations is daunting.  But the truth is, independent physicians are leaving money on the table with their existing fee-for-service contracts.  Whereas entering into value-based care arrangements with a group or company that offers managed services support offers easy ways for providers to earn VBC incentives for the work they are already doing currently. 

However, merely partnering with a group doesn’t always accelerate VBC adoption and success.  Many organizations require practices to adopt a specific EHR, use a specific tool to monitor data, or even mandate certain practice policies, and all have certain fees. Practices should feel that they are able to have input on the reports and data they are being evaluated on, and not be at the mercy of any specific tool.   

That said, it’s critically important to have reports that identify care gaps, and provide the right information to the right care team at the right time. Adopting approaches and strategies in treatment that are data-driven will not only result in more healthy patients, it will also result in dollars saved for physicians over the long run. 

With data- and analytics-based insights guiding the way, independent care providers in a value-based care model can address their patient base’s needs from a population level on down – ramping up preventative care, taking better care of patients, and reducing costs of the system in the process. What’s more – the more effective practices become at this process, the more their reimbursement dollars go up. 

As practices mature in value-based care arrangements, the models can also advance into risk-bearing entities and alternative payment models. The benefit of moving to risk-bearing VBC models lies in the potential shared savings. When practices join a value-based care contract, these practices then work collectively to reduce costs and improve outcomes and are evaluated on their progress toward these goals. When the group excels, all members share in the reimbursement with what is called “shared savings.” And when the group falls short of a target, the penalties are doled out equally – with all members of the group equally sharing the risk.  

However, even the highest performing independent practice often can’t afford to put dollars at risk. This is another reason to engage with a company, or managed services organization. There are organizations that work with independent physicians to not only adopt value-based care strategies, but also to provide the financial backing for an independent physician that take on the benefits of risk-bearing arrangements without actually being responsible to pay those potential out-of-pocket costs.  

Independent practices still on the fence about implementing value-based care ought to consider that some companies, or managed services organizations such as CIPA+, cover the risk portion entirely – eliminating any potential negative adjustments, and leaving only the possibility for positive reimbursements. 

Where to Start Implementing Value-Based Care 

Independent practices wondering how to implement value-based care models have a few good places to start. For one, practices should ensure that their EHR, finance, telehealth, remote patient monitoring, and other healthcare IT systems are all optimized and running properly. As these systems are all important for sourcing the data which will ultimately lead to reimbursement under value-based care models, having them running smoothly is important. 

Next, it is certainly a good idea to communicate with your staff before you make any adjustments to your business model. Now more than ever – with burnout in healthcare being at record levels – staff buy-in and clear communication are important to keep your staff on board. Talk to them before, during, and after you implement any changes – and take what they have to say into account. Making staff feedback part of your plan for implementing value-based care will not only make them more satisfied, it will also increase your chance of success down the road. 

Lastly, implementing value-based care will of course require entering a group contract that is right for you, and with a managing organization that does not charge membership fees or place unnecessary risk with the practice. Additionally, it is worth asking potential organizations about their requirements with technology and tools, and what the ongoing hands-on practice support consists of. Is there someone accessible to you in real-time, or do you have to wait on hold for phone support? Will there be staff identifying the best opportunities for your practice? Or do they post reports online and tell you to go log in to retrieve them? 

Finding a contract, and an organization that is the right fit and advocate for independent physicians is critical to the adoption and success of value-based care. Be sure to take your time when considering potential groups and contracts. Medical Advantage’s CIPA+ is a Michigan-based group contracting entity which covers the risk for all member groups and is a good option for first-time members of value-based care plans. CIPA+ was started as an IPA with only Michigan’s independent physicians. With decades of experience in negotiating payer contracts for, or on behalf of independent physicians, CIPA+ has achieved excellent patient outcomes and distributed millions of dollars directly to physicians. 

Medical Advantage’s CIPA+: An Option for Independent Practices Shifting to VBC 

While the benefits are overwhelming – both for patients and for care providers – making the shift to value-based care can be daunting, especially for an independent practice. Medical Advantage and CIPA+ can help. CIPA+ is group-contracting entity that covers 100% of the downside risk for member practices, offers hands-on support to attain successful outcomes, and requires $0 in out-of-pocket fees from practices. As an entity that has its roots in advocating for, and representing independent Michigan practices, we continue to be a smart choice for an independent practice looking to implement value-based care. 

For more information about joining CIPA+, contact one of our consultants today.