Three fundamental shifts to help LTC providers pave the way for value-based care

John Smithwick
John Smithwick

Healthcare organizations of all shapes and sizes are trying to figure out how to make the transition to a value-based world in a cost-efficient and timely manner. In fact, a recent McKnight's article by John O'Connor raises this very issue:

While important details are yet to be finalized - such as exactly what kind of bundled payments SNF operators will receive - there's no doubt that operators who rely on Medicare funding will have to reconsider how they do business. Among the questions that merit special attention:

●      How will our organization embrace new strategies that ensure survival in a reimbursement environment that puts a premium on value-based care?

●      What specific kinds of care do we need to deliver going forward?

●      What's going to separate us from the competition?

John is right. The transition to value-based care will reshape the delivery of care at every stage along the care continuum. And CMS' new policy has added a clear sense of urgency. Moving forward, the federal government will pay Medicare doctors more if they help patients get healthier - and less if their patients don't make progress toward recovery. How? By tying 85% of all Medicare payments to outcomes by the end of 2016 - and increasing this target to 90% by 2018.

In response, leadership at healthcare organizations are looking for ways to eliminate waste and operate more efficiently. One solution with promise? Care management platforms that extend the delivery of care beyond face-to-face encounters, and proactively identify risks that may lead to adverse health events.

Technology can provide the capabilities providers need to redesign care delivery processes, but adopting new technology must go hand-in-hand with clear organizational goal-setting that prioritizes enhancing the experience and outcomes of the patient, while reducing costs.

For long-term care providers, there are three fundamental shifts that can help pave the way for value-based care:

1. From siloed, episodic care to integrated, team-based care.

The days of individual providers churning out care in a vacuum and moving on to the next patient are in the past. As long-term care providers shift to a value-based reimbursement model, more multidisciplinary clinical teams will need to mobilize a patient-centered approach to collaboration to improve outcomes and reduce costs.

Instead of working independently of one another and requiring several phone calls, massive amounts of paperwork and transfer of records from multiple electronic health record systems, long-term care facilities should look for solutions that enable shared workflows and pathways for tracking patient status and interactions between clinician team members. By taking a coordinated approach to care, instead of one where each provider works in relative isolation, clinician teams work together using a shared platform to more reliably prevent expensive adverse health events. This is especially important for care transitions, which can be difficult for patients and clinicians if technology doesn't enable open and easy collaboration.

2. From technology to help document and bill for services to technology to help providers achieve the best outcomes possible.

In recent years, many health systems have invested in extensive - and expensive - platforms to optimize billing and financial operations. As we shift toward value-based reimbursement, optimizing care and outcomes are becoming essential to the success of healthcare organizations. Care management technology can help achieve these goals, while also integrating with existing systems, to put actionable information in the hands of clinicians at the point of care.

In a risk-based world, providers need to be aware of their patients' known and potential health risks. More importantly, they need to get in front of those risks and neutralize them through small data-informed, personalized care plans. By using care management technology, clinicians can do everything from virtually checking in with patients and providing them ongoing medical services to accessing real-time patient data to better predicting potential future adverse health events. By implementing technology that enables both patient communication and sharing of patient-generated health data, long-term care providers can have more control over improving outcomes and reducing costs.


3. From face-to-face encounters only to multi-modality encounters.

Most long-term care providers use a traditional rounding model, supported by in-person visits from physicians or other care team members when required. Though this works well, face-to-face patient encounters require several hours of time, often making them difficult to be ongoing and regular for patients and clinicians. By utilizing and combining new modes of communication - phone and web-based secure messaging - long-term care facilities can have more frequent and productive patient touches. Non face-to-face care management can be an incremental revenue stream.

With these more easily executed and frequent check-ins, information gathered can enable clinicians to determine which patients need additional support and potentially an in-person visit. In this patient-centered, provider-led model, every interaction becomes more meaningful.

Not only is this model cost-conscious - its light-touch approach is appealing to patients, allowing them to use their preferred device to respond and engage when most convenient.

Virtual and phone interactions also have an additional value: Improved transparency. LTC patients are more likely to admit to non-compliant actions when asked via a call or online platform than they are when confronted face-to-face by their doctor.

I believe that the future of LTC depends not only on the impact of effective patient engagement, but on the impact that integrated care management holds for the space. A tightly blended mix of patient engagement and care coordination can help LTC providers transition to a value-based world, and position them to provide the best outcomes for their patients.

Patient engagement that is frequent enough, dynamically tailored to the unique needs of the individual and actionable for the clinician team will be essential to any risk-bearing entity. Combined with technology that makes clinician engagement and workflow faster and easier, LTC providers will be able to optimize operations, create impactful, informed and personalized care plans for patients all while staying profitable.


John Smithwick is the CEO of RoundingWell.  He co-founded RoundingWell in 2011 following four years at Nashville's Healthways, where he led the design effort for their web-based disease and lifestyle management product offerings. 

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