How physicians can overcome challenges with value-based care
This blog was originally published in April 2022 and was updated in April 2024
The move to value-based care, and away from fee-for-service models, began in 2008 with the launch of the Medicare Improvement for Patients & Providers Act (MIPPA). With the Affordable Care Act (ACA) of 2010, several new programs entered the value-based care picture. There continue to be several value-based care challenges, particularly for new independent practices. In this article, we will break down the different problems with value-based care and provide different solutions for physicians hoping to shift to value-based care.
7 key challenges with value-based care
A recent Definitive Healthcare survey asked over 1,000 healthcare leaders about the value-based care landscape. Their responses pointed to some of the biggest value-based care challenges, which included:
1. Changing regulations and policies
The shift from fee-for-service healthcare to value-based care has been underway since the passing of MIPPA in 2008. Since that time, CMS has been introducing and consistently modifying value-based incentive programs, which makes it difficult for physicians to keep up with changing regulations.
2. Time constraints
Along with staying up to date with changes made to value-based incentive programs, physicians must also put additional time into implementing value-based care practices. Value-based care requires that physicians spend additional time on activities such as patient education, care coordination, and data reporting. Staying on top of these tasks, along with their existing clinical responsibilities, leads to burnout and reduced job satisfaction.
3. Trouble with collecting and reporting patient information
Physicians hoping to practice in a value-based care model may struggle to appropriately coordinate care for their patients. This is due to fragmented healthcare systems and varying levels of interoperability between EHR systems.
4. Gaps in interoperability, internally and externally
Interoperability continues to be a challenge for providers. Value-based care requires an unprecedented amount of healthcare data exchange and analytics, so adopting technology solutions like interoperable EHR systems, patient and provider engagement technologies (like telehealth technologies), and core operational and financial applications are critical to moving forward with value-based care.
5. Unpredictability of revenue stream and complexity of financial risk
One of the biggest value-based care challenges is the unpredictability of the revenue stream and the difficulty in understanding the complexity of financial risk involved in these programs. Moving to a value-based care model may cause practices to struggle with adjusting their revenue models and cash flow, which can lead to problems with sustainability and profitability.
6. Lack of resources
Physicians are challenged by staffing shortages and may need to learn how to capitalize on rising opportunities such as implementing health IT systems to handle population health initiatives.
7. Understanding and meeting performance metrics
Value-based care models often involve complex performance metrics and quality measures. Physicians may find it challenging to understand and meet these metrics, particularly if they are not aligned with their clinical priorities or if the data used for measurement is incomplete or inaccurate.
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Solutions for overcoming problems with value-based care
Even though some physicians are reluctant to practice in a value-based care model, there are several benefits of value-based care for physicians, including improved patient relationships, better care outcomes, and reduced healthcare costs. Additionally, there are several solutions for overcoming problems with value-based care, including:
1. Providing appropriate provider compensation and incentives
Under the current system, providers can opt into value-based purchasing initiatives, receiving bonuses for performing above average and being penalized for performing below average. However, more clarity may be needed to entice providers to participate in value-based care programs.
2. Investing in an EHR purpose-built for value-based care
Physicians who want to practice within a value-based care model would greatly benefit from investing in a value-based care EHR that’s tailored to physicians practicing value-based care. The vast majority of EHR systems on the market cater to traditional fee-for-service models and don’t accommodate value-based care models. An EHR that supports value-based care allows physicians to manage population health initiatives and easily compile clinical quality measure reporting.
3. Practicing remote patient monitoring
Monitoring patients outside of health settings is important for staying on top of patients with chronic diseases. Remote patient monitoring allows providers to proactively identify and track patients with specific health conditions or risk factors and deliver high-quality care to help prevent complications and improve patient outcomes. This can be done through telehealth software, as well as other tools such as remote heart monitors, blood pressure monitors, and more.
4. Ensuring seamless interoperability in your EHR system
Interoperability is a critical component of effective care coordination as well as value-based care, yet interoperability continues to be a challenge for physicians practicing in a value-based care model. With an interoperable EHR system, healthcare providers can access and share critical patient information with labs, hospitals, and other practices seamlessly, which enhances care coordination and improves patient outcomes.
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While practicing value-based care can be a challenge, this model is the best way to deliver great patient care and improve patient outcomes. Elation offers a complete EHR system that’s purpose-built for physicians practicing in a value-based care model. Our EHR includes extensive patient outcome reporting features and clinical quality measure reporting so you can earn full Medicare CPC+ or MIPS incentives. Additionally, our ONC-certified EHR is interoperable, allowing you to seamlessly send patient data to external labs, hospitals, and other practices, so you can improve care coordination.
Elation helps you improve patient outcomes at scale and deliver great patient care at scale so you can succeed in value-based care. Download our free eBook to learn how to succeed in value-based care, and learn more about Elation’s value-based care EHR today!
FAQs
What is value-based care?
The Centers for Medicare & Medicaid Services (CMS) defines value-based care as programs that “reward health care providers with incentive payments for the quality of care they give to people with Medicare.” Value-based care is a healthcare delivery model that emphasizes achieving the best possible outcomes for patients while also controlling costs.
What are the pros and cons of value-based care?
There are several pros and cons of value-based care. On the positive side, it emphasizes patient outcomes over the volume of services, potentially leading to cost savings and improved patient experience. Incentivizing quality improvement and population health management are key strengths, encouraging proactive approaches to healthcare delivery.
However, the complexity and administrative burden associated with implementing value-based care, coupled with financial risks for providers, pose significant challenges. Data and technology hurdles, along with the potential for unintended consequences and provider burnout, must be carefully addressed. Despite these obstacles, effective implementation and ongoing evaluation can maximize the benefits of value-based care while mitigating its drawbacks, ultimately driving better outcomes and affordability in healthcare.
How can physicians succeed in a value-based care model?
Physicians can excel in a value-based care model by prioritizing patient outcomes and satisfaction, implementing effective care coordination practices, and leveraging data analytics to inform decision-making. Continuous quality improvement efforts and staying informed about evolving healthcare policies are also essential for success in a value-based care environment. Ultimately, by adopting these strategies and remaining adaptable to changes in healthcare, physicians can enhance patient care, reduce costs, and thrive in a value-based care model.
