The healthcare industry is on the brink of a fundamental change: Healthcare providers are transitioning from a fee-for-service model to a value-based-care model. This change will impact virtually all aspects of how healthcare providers work, manage day-to-day processes, and receive payment — and the software applications they use will need to support this new way of caring for patients and managing business.
What Is Value-Based Healthcare?
Cleveland Clinic defines value-based healthcare as “simply the idea of improving quality and outcomes for patients.” To reach those goals, healthcare providers will focus more on preventive screenings and overall wellness and standardize care delivery by employing best practices.
For example, patients with diabetes will have a better chance of avoiding complications if they stay well, and they can receive comprehensive care if their primary doctors, nutritionists and other providers work together to coordinate their care.
Value-based healthcare has two primary benefits:
- Better care: Instead of patients receiving uncoordinated services patients receive care from integrated healthcare provider teams that focus on keeping patients well.
- Lower costs: With the current fee-for-service model, healthcare providers get paid by the number of procedures they perform or services they provide (which some people believe encourages doctors to order more services). With value-based care, healthcare providers are paid based on outcomes. Teams work together to eliminate wasted effort and redundant services, saving the patient — and healthcare plans — money.
Software Applications that Support Value-Based Care
There are a number of software applications and features that healthcare providers need to effectively operate using the value-based care model, including:
- Data Analytics — To establish best practices and then continuously refine processes to optimize outcomes, healthcare providers need data analytics solutions that show what works vs. what doesn’t and that deliver actionable insights.
- Access to Information — A patient’s care team will need to have access to a variety of important data — but the entire care team may not work at the same facility or even in the same town. Healthcare providers need the ability to access vital data and to keep data secure.
- Communication — Care teams also need the ability to collaborate and communicate effectively and securely. When it comes to patient care, time is often of the essence. Teams need reliable ways of reaching each other and confirm that critical messages were received.
- Care Management and Workflows — Recordkeeping, scheduling, and other day-to-day workflows will change with value-based care. Healthcare providers’ staffs will need solutions that eliminate additional time spent on these tasks and allow them to focus on patients.
- Payment — Value-based healthcare will also change the way providers are paid. Instead of billing per service or procedure, providers may use bundled payments — providing one bill for an entire course of care. There is some risk to healthcare providers with this model. Bundled payments are based on historic costs for services — but if a patient requires more care than usual, the provider could experience a financial loss. Providers will need solutions that allow them to make accurate estimates.
Providers will also need a way to track and account for incentives. The Centers for Medicare & Medicaid Services (CMS) explain that value-based programs reward healthcare providers with incentive payments for the quality of care they give patients on Medicare. Administrators will need software applications that take this into account.
The Healthcare Industry is Looking for New Solutions
Although healthcare IT solutions providers are beginning to address value-based care, the industry is actively looking for solutions to the new challenges it creates. A Sage Growth Partners Survey found that healthcare providers report their value-based care needs are currently not being met. For ISVs serving the healthcare industry, the transition to value-based care could represent a significant opportunity.