Game-changing value-based reimbursement models are radically altering the healthcare landscape. CMS’s new program, Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), along with the expanding Bundled Payment for Care Improvement Initiative (BPCI) are dominating headlines, calling into question physician and organizational readiness and the ability to address complexities that impact the revenue cycle.
These new payment models will require clinicians to collaborate around their patients in ways that they have not done so in the past. Increased collaboration is necessary to effectively coordinate a patient’s care among care team members who cross ambulatory, acute and post-acute care settings and organizations. To quote one esteemed health system nursing executive, “If you can’t communicate and exchange information with all of the people involved in an ACO or other new risk-sharing model, you can’t deliver quality care.”
However, many obstacles exist – brought about by healthcare’s fragmented cottage-industry structure – which critically hinder efficient care team collaboration. Inefficiencies are inherent in this siloed work culture, which if left unaddressed can lead to compromises in patient safety and employee relationships. The inevitable lack of communication, coordination and access to critical information points to our most prevalent problems with patient care.
Collaborating under one payment model, one price
This concept is best illustrated by Michael Porter and Robert Kaplan in an article from the July-August 2016 Harvard Business Review in which they offered a simple analogy between buying a car and paying for healthcare services. According to the authors, consumers do not buy the motor, the brakes, the seats, the wheels and other individual parts from different suppliers. Instead, “They buy the complete product from a single entity.”
Like the automotive industry, our healthcare system comprises different suppliers – different healthcare professionals employed by different organizations who provide components of care in a single episode of care. However, unlike the automotive industry, patients rarely, if ever, pay for all of these services from a single entity. Bundled payment aims to change this paradigm.
However, numerous navigational barriers exist in provider-to-provider communication, primarily because each organization possesses different workflows optimized around their own needs for how they receive communications. This ranges from identifying and coordinating the right specialist for a consult, to arranging physical therapy and tests.
To echo Porter and Kaplan, it just makes good sense to collaborate under one model and one price where all suppliers unite to assemble a car—or administer care—in the most efficient manner for the consumer/patient, which is where value-based payments come into play.
Rethinking strategies and tools for bundled payments
Under the new bundled payment model for as many as 48 clinical conditions, CMS will disperse one lump sum to the health system or hospital covering a patient’s entire episode of care. This means that organizations must rethink the most effective strategies and supporting tools to coordinate care activities among a network of acute and post-acute provider participants in a community—and pay them.
Without a doubt, efficient care team collaboration and patient-centered coordination are the nexus of transformative change. To accelerate this level of collaboration, innovative communication technologies are necessary to support this new era of incentivized care. But these communication technologies must be purposefully designed and extend beyond the EHR (and the hospital).
Transforming care with communication technology
The level of collaboration required means that providers need communication technology that transcends geographic and organizational barriers. It must enable and expedite contact among care team members who work in and across multiple coordinating facilities and locations.
In addition, this communication technology must be able to identify and provide immediate connection to the “right” care team member for a given clinical situation. This type of logic requires that—for every single communication by every care team member—the contextual variables of each interaction must be analyzed in real time to ensure communications are routed to the correct individual based upon the recipient’s workflow.
Bottom line: MACRA, BPCI and other market forces are imposing high demands on the care team in making clinical communication and collaboration even more critical for success under value-based care. Leaders in medical practice can take heart in the creation of a permanent impetus that meets the needs of the patient to achieve stronger correlation of the best health outcomes, while rewarding their care services. Assessing communication technology and business processes is a logical place to start.