Value-Based Care: The Basics and Beyond

Moving forward, value-based care (VBC) will be the norm in post-acute and long-term care. In a recent PALTtalk podcast, guest Walter Lin, MD, MBA, shared his insights on how implementing patient-centered models can improve outcomes while reducing costs.

Dr. Lin started with a definition. He said, “Value-based care is a way of caring for our patients to achieve better outcomes while reducing health-care costs. In this model of care, providers are incentivized to provide high-quality, accountable care and, hopefully, in doing so, provide more efficient care as well.” He added, “I think we are all very motivated to take better care of our patients, and if we can be further incentivized to do so by sharing in the savings that we helped create, I think there's a very aligned set of incentives motivating to us as providers.” Among his other insights on this topic:

• Fee-for-service, which PALTC practitioners have used for years, has historically been a volume-based payment system without any accountability for cost or quality for the patient. Under VBC, Dr. Lin said, “The whole idea is to make a provider accountable for quality and cost outcomes and incentivize them to do a better job of managing both.”  
• The clinical strategy strategies that PALTC practitioners employ to take better care of their patients are threefold. As Dr. Lin explained, “One is to understand the goals of care of our patients and have the appropriate advanced care plans in place so that we can align what we do with what our patients and their families want to be done. Second, I think, it's important to have a clinical model that enables us to detect changes in condition early and have abilities to treat patients in place as opposed to sending them to the hospital or emergency room unnecessarily. Third, it's also very important to provide optimized preventative and routine care, so we want to address issues like polypharmacy.”
• When practitioners think in terms of operationalizing a clinical model that can achieve better outcomes, this may be a bit more challenging, especially if they don't have a say in which value-based programs their organization participates. Clearly, it’s important for physicians and other clinicians to understand VBC and have a seat at the table in decision-making at their organizations.
• Dr. Lin suggested that, ultimately, by providing high-quality care, “even though we are often working much harder, we can achieve overall cost savings for our patients.”
• When practitioners can spend more time with patients/residents, they can better keep them out of the emergency room and hospital. “We often can provide the same level or even higher quality care by treating them in place because of the trauma that's often caused with transitions of care in our patient population,” said Dr. Lin. “This higher quality care often costs less, and you're achieving savings. This payment model supports our basic care needs to be able to distribute some of those savings back to those involved in the care, whether it be the providers or the nursing home.”  
• It’s important to be able to have good goals of care discussions and provide a meaningful clinical response to changes in conditions. A growing focus on home-based care, patient and family education, and engagement is needed so they recognize the early stages of condition changes and know when to contact the physician or other practitioner.
• “As clinicians, we're all very motivated to achieve better outcomes for our patients, but often we don't know what those outcomes are,” Dr. Lin said, “so a very key component of value-based care is data transparency. We need to know how our patients are doing from the quality as well as the utilization perspective.” This means having data in real-time as much as possible, as well as the ability to use that data to continue to iterate and improve care models.
• Ideally, Dr. Lin suggested, “We will share in the savings that we help create with all the extra hard work that we do. It takes a lot of extra effort to keep them out of the ER and hospital, but it's better for the patient, so I think it's important to allow providers under value-based care to share in the savings they help achieve.”

Go here for more of Dr. Lin’s insights and his conversation with podcast host Diane Sanders-Cepeda, DO, CMD.