Keys to value-based care: PCPs, technology innovation, SDOH and health equity

Photo: Equality Health

Tackling value-based care is crucial with the upcoming 2030 mandate by CMS. But it can be challenging for providers to deliver equitable care while hitting value-based care goals.

Still, providers don’t have much of a choice since value-based care is replacing fee-for-service as the method of reimbursement in the industry.

To get a look at value-based care from the primary care provider’s view, we sat down with Brandon Clark, chief strategy officer at Equality Health, a value-based care company that partners with independent primary care physicians under Medicaid contracts to take on risk and unburden providers. It has more than 3,200 PCPs in its network and partners with 25 health plans.

We wanted to know why Clark believes PCPs are so key to success in shifting from fee-for-service to value-based care, what kind of innovation and technology is needed to help providers achieve value-based care success, and how social determinants of health and what Clark calls “culturally competent care” are important to value-based care.

Q. Why do you believe primary care providers are so important in the healthcare industry’s success in shifting from fee-for-service to value-based care?

A. We believe independent primary care practices – those not tied to larger hospitals and health systems – are the crucial engine of change for the U.S. healthcare system’s shift from the entrenched volume-based care model to that of value-based care.

Why primary care? The primary care workforce is on the frontlines in communities across the U.S. as the first and longitudinal point of care, especially in underserved communities, which often present the most complex patient panels for physicians.

As the backbone of the U.S. healthcare system, primary care providers deliver nearly all the services responsible for people living longer, healthier lives. Operating in and serving local communities, they play a significant role in the success of value-based care, where the goal is to deliver enhanced patient care with better outcomes at a reduced cost.

To help diagnose, treat, manage and prevent the chronic conditions that plague so much of the country, primary care providers have the opportunity to see the whole patient story, including social determinants of health and other non-medical forces that drastically impact health.

Keeping people healthy, managing ongoing health conditions, and keeping people out of more expensive acute care settings like EDs and hospitals is focal to the success of value-based care.

Primary care resources across America are in the best possible position to make that happen. What’s really interesting is that so many of these independent PCPs are already practicing value-based care methodologies. Yet they are tremendously under-resourced and under-supported, with many on the cusp of extinction.

To remain fiscally viable and independent, they require partnership and tools. They need the right support so they can focus on what matters most – spending more quality and effective time with patients.

Q. Many in healthcare say the administrative burden of value-based care is enormous for providers. With this in mind, tell me what you think is the kind of innovation and technology needed to help providers achieve value-based care success?

A. With any significant change, there always are change-management efforts. Value-based contracts come with new requirements and new metrics/reporting, and that puts pressure on the small and already over-taxed teams at independent primary care practices.

They need access to technologies that help automate labor-intensive back-office functions, identify and close care gaps in their patient panels, and flag high-risk patients or patients who may struggle with SDOH.

They need hands-on, dedicated support, such as practice performance managers and community health workers to help them succeed in value-based care.

Providers are frequently asked to organize their work around multiple, or even dozens, of different payer-specific value-based care programs. Equality Health consolidates these initiatives into one single platform, integrating the practice’s panel into an aligned value-based ecosystem, and truly changing the way care is delivered.

As well, these practices need fiscal support. Some alternative payment models pay providers months after the delivery of care. Innovative new approaches from partnership organizations bearing the financial risk and paying these practices incentives on time or early are tremendously helpful in freeing PCPs from financial burden.

For the new value-based model to work, PCPs need tools and resources that allow them to focus on delivering whole-patient care to drive better outcomes and reduce costs.

Q. Social determinants of health are crucial to the future of new care models. You talk a lot about culturally competent care. Please elaborate about this approach and its importance to value-based care?

A. Racial and ethnic disparities have existed in U.S. healthcare for centuries. The pandemic brought even more awareness to this issue, revealing the importance of accounting for cultural factors when providing patient care.

On a broad scale, providers and clinicians have the understanding that culture plays an important role in prescription adherence, behavior modification, patient satisfaction, and the way different cultural groups use the U.S. healthcare system.

But many clinicians lack the right tools that provide practical and tangible ways of embedding cultural beliefs and preferences into their work at the point of care. They need to incorporate culturally competent care delivery into their day-to-day practice of medicine in a way that enables them to drive better outcomes for different cultural groups including African American, Indigenous American, Latino, LGBTQ+, seniors and young adults, among others.

To account for SDOH, clinicians can engage with patients to understand the challenges they face, then analyze those findings for common trends among various patient populations, and, finally, connect patients with the community-based organizations that can help them address those challenges.

The only way to improve health outcomes and reduce costs is to address patients with a culturally competent approach. Supporting PCPs by delivering the training and tools to help them deliver such care is instrumental to value-based care success.

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