In a recent “Keeping up with COVID-19” webinar, Moshe Starkman, nThrive senior director, Value-Based Reimbursements, discussed how the current Coronavirus pandemic is impacting value-based care at hospitals and healthcare organizations across the country, and why it is likely to evolve rapidly to better prepare for future public health crises.
“What COVID has done is expose the gaps in our ability to provide care during unexpected circumstances,” Starkman said. “We did not adequately address COVID until it overwhelmed us, and we had no choice but to face it with the seriousness that it deserved.”
In a value-based care system that is oriented around preventative care, Starkman emphasized that greater population health adoption and natural (i.e. not mandated, social distancing/self-preservation practices) would be more readily applied. Identifying high-risk patients, as well as promoting public health guidelines that improve patient education and consider the nuances of current circumstances, would have made for a less damaging resolution to the current pandemic.
“We know that COVID-19 affects certain people more than others with reliable precision. The application of sweeping, one-size-fits-all regulations, while losing nuance in healthcare and causing untold psychological damage across all demographics, is a sad demonstration of reactionary healthcare that is both costly and increasingly indefensible. The realities of a shrinking world where international and interstate travel is commonplace has forced U.S. healthcare to increasingly adopt outcomes-oriented, patient-centric value-based care models over traditional fee-for-service (FFS) models,” he added.
Impact on Medicare Shared Savings program
Starkman quickly put to rest the healthcare industry concern that COVID-19 would negatively impact healthcare organizations currently enrolled in Medicare Shared Savings programs due to unexpected expenditures related to the pandemic.
“COVID-19 is putting unnatural stress on these value-based reimbursement programs and the Centers for Medicare and Medicaid Services (CMS) recognizes this,” he explained. “CMS understands that the quality data furnished during the emergency is not reflective of true care, therefore it is suspending data from January to June 2020 (and possibly longer). Physicians will still qualify for relief and get a neutral payment adjustment, even if they did not submit data by the April deadline.”
Why traditional care isn’t the long-term answer
“Traditional care is reactive, inefficient and too expensive,” Starkman explained, noting that, even before COVID-19, “the cost of healthcare has been the number one cause of bankruptcy in America and more than 25 percent of Americans delayed serious treatment of their condition(s) due to cost in 2019.” In a value-based care approach, he explained that costs to consumers are reduced through better coordinated care and greater emphasis on overall patient health and wellness promotion.
“It is an investment in your healthcare rather than coverage of a general population. This is the defining distinction and encourages personal responsibility and the self-promotion of one’s health and wellbeing,” he said.
In this value-based care scenario, the healthcare industry would shift toward:
- Significant changes in point-of-care, including home-based healthcare (HHC) /PCMH and higher use of telehealth
- Broader understanding on the implications of co-morbidities, including diabetes, heart disease and other preventable illnesses
- Greater adoption of managed wellness plans, with people seeking help sooner and acting on incentives related to wellness promotion
Transitioning to value-based care post-COVID-19
“The first step is recognizing there is a problem,” Starkman emphasized, noting that the cost of traditional healthcare had prevented many people from getting the care they need pre-COVID-19, and was recognized decades ago as a barrier in times of crisis.
“In 2001, post 9-11, we did an assessment of security risks in the United States and it was determined that a pandemic was the number one risk facing our country – a greater risk than terrorism,” Starkman explained. “We knew 15 years ago that we needed protocols and equipment to prepare for an anticipated pandemic. Nevertheless, the U.S., though scoring better than other countries when it comes to preparedness, did not have the healthcare infrastructure capable of meeting the needs of this highly infectious disease. Thank goodness it only impacted a relatively small subset of our population. One could only imagine the devastation if this virus took the same toll on children as it did on seniors, an experience that is more normal with Corona viruses.
“We can and must do better.”
What does the future look like?
Starkman cited The Learning Action Network, a group established by Health and Human Services (HHS), which estimates that 100 percent of Medicare will be risk-based by 2025, with Medicaid and Commercial payors both estimated at around 50 percent.
“Medicare already has demonstrated a strong, bi-partisan commitment to moving towards value. The successes of many programs, and the already realized savings and Medicare cost reductions, mean there’s no going back,” he emphasized.
Healthcare data analytics is an enabler
“Value-based care only works if you have good analytics behind it,” Starkman explained. “Maintaining patient data in actionable patient profiles is critical. Actionable profiles will enable care providers to improve clinical interventions and anticipate financial outcomes for different patient risk segments while enabling consumers (i.e. patients), to view, download and better understand their health status.”
With analytics from nThrive, it is possible to effectively achieve the Institute for Healthcare Improvement’s (IHI) Triple-Aim, enabling coordination of medical needs across populations to improve the quality of patient solutions, while lowering costs and enhancing patient experience throughout the continuum of care.
The evolution of health information technology, including electronic medical records (EMRs) and the Internet of Things (IoT), will further enable hospitals and healthcare systems to see beyond descriptive data through predictive and proscriptive healthcare data analytics.
Ultimately, Starkman emphasized that these changes are aimed at designing a healthcare system that is “in all of our best interest,” adding “as we say, value-based care is the ounce of prevention that is worth a pound of cure.”