Optimizing care model transformation and redesign

Part 1: Why provider organizations need to spend more time on integrated care management

Many health care provider organizations are turning to value-based care (VBC) business models and contracts in response to cost pressures, fee-for-service model shortcomings, federal policies and regulations, and consumer expectations. These new payment models tie reimbursement to outcomes and align incentives with reducing the total cost of care. Payers are currently in hot pursuit of more robust and substantive partnerships with providers. Success depends on the ability of health systems to effectively manage population health risks while delivering high-quality care and growing the number of patients attributed to these contracts.

The COVID-19 pandemic has exposed fee-for-service model shortcomings, leading to delivery model changes and improvements as well as the increased adoption of digital and virtual solutions. Virtual care and telehealth usage is commonplace, helping to reorient care delivery to prioritize consumers’ preferences. In addition to providing convenient ways for patients to engage with health systems, virtual health presents health care organizations with compelling new opportunities to gain data-driven insights on their patients and connect patients to optimal clinical resources.

Learn more about efficiently managing the total cost of care, why technology and data matter, and how we can help your company modernize patient engagement in our first blog post on care model transformation and the future of integrated care management.

Part 2: Care model design elements

As the health care industry shifts to VBC, health plans and providers can utilize several levers to take advantage of financial incentives and the willingness of patients and members to engage with the health care ecosystem. Often, organizations will begin their journeys to value-based models by redesigning their contracting strategy. Yet it’s care model transformation that enables them to realize contracting targets and financial incentives.

Two critical components of operational change when transitioning from a fee-for-service model to a value-based care model include care model redesign and enabling automation and analytics. The second installment of this series explores the key design elements of an integrated care management model transformation and provides a preview of the enabling analytics lever to be discussed further in part three.

Part 3: Supporting care model technology and analytics

Technology and analytics are essential to care model transformation and redesign. These enablers are used in care management to identify patients with impactive needs, determine the care team members who can make the biggest impact, and measure volume and capacity to rightsize the care team.

In this blog post, we discuss how technology and automation contribute to care management programs, as well as the pain points and critical success factors that our team encountered at various client organizations. Take a deep dive into multidimensional identification and stratification, the patient auto-assignment process, and the custom staffing approach.

Part 4: Value of the transition

The adoption of a value-based care model is no small feat, and that is often the impediment to change. But the current health care landscape is adopting (or sometimes forcing) innovation at an accelerated pace, enabling better outcomes supported by a multidisciplinary, patient-centric care model. In our support of plan and provider care model redesigns, several key value themes for patients, providers, and health care organizations commonly arise.

In the fourth and final entry in this series, we uncover the benefits of care model transformation and explore considerations for measuring financial impact. Discover the multiple ways in which we encourage our clients to measure the impact of the shift in the population health model.