There is a common misconception about all value-based care delivery models being unique. If this was the case, the lessons learned from the models would not be replicable. While the starting point for many value-based care delivery models may be unique, they are conceptually quite similar to each other.

The underlying feature in all of these models including Accountable Care Organizations is that they are designed to help providers get ready for reimbursement changes while sustaining a business model for the future. In order to succeed, they must improve the quality of care while reducing costs in order to maintain profitability.

The starting point

The most important question for many organizations is how to start these efforts, and at what point. It depends on:

• An organization’s readiness to change the current structure
• A strategic plan
• Management’s readiness
• The projected budget

If a healthcare organization has the infrastructure, commitment and budget to take a big leap, a more rapid transformation may be possible. In reality, it’s rare that an organization is fully prepared to address all the factors above immediately. The vast majority is only able to meet two or three factors.

Most healthcare groups will require a tiered approach. It will include an initial focus on providers and member incentives within a clinical setting in order to participate in shared savings. When they meet the basic quality targets, they can then move on to higher risk models including revenue sharing contracts or provider-led health insurance products.

Managing risk and optimizing rewards

Risk-based approaches are becoming very common as early adopters become more experienced. There are attractive options in terms of more revenue as well. Many of these strategies focus on member incentives and engagement. Early experiences with these models illustrate that it’s not enough to solely rely on provider incentives to drive appropriate utilization. The insurance side must also align members with the desired quality objectives. An example would be to reduce or eliminate co-pays for diabetic members to improve medication and treatment compliance.

Additionally, patients also need better access to their data to help them make better healthcare decisions. This can include types of services available, costs of these services and their usage. Patient portals and mobile apps are an ideal platform to start implementing these resources. Patients are already interested in getting more control over their healthcare concerns and the need of the hour is to weave these resources together in order to make the overall healthcare experience better.

The time to begin is now

There are still many organizations playing the “wait and see” game. Their management is unwilling to acknowledge that the healthcare industry is undergoing a dramatic shift. As a result, they are not investing their time and resources to move towards better integration. As a suggestion, the waiting game is not the right option at the moment when there are revenue-generating strategies available immediately.

The right approach is to choose a starting point and begin building the structure, culture, and technology to prepare for the future.