The switch from a healthcare industry driven off of a fee-for-service model to one that emphasizes value-based care is not just in full gear. According to some industry experts, the time has passed when fee-for-service health networks can expect to operate efficiently anymore. To keep patients engaged, there needs to be a new healthcare system that caters to their needs, as well as a new kind of physicians network that provides those services.
That is the message coming out of the annual meeting of the Healthcare Financial Management Association, Healthcare Finance News reported. While physicians may at one point have been content to let patients come to them, the atmosphere of clinical care has changed to the point where if clinicians are not available when and where their patients require their solutions, it may be too late to win them back, and the costs of losing them to out-of-network services might be too high to stomach. That is why Daniel Marino, senior vice president of The Camden Group, told attendees to the HFMA event that integrating physicians in a vertical model is critical to providing near-constant access to care.
Coordinating care is critical to costs
In decades past, it was both cost effective and tolerated by patients to provide a single physician for all of their healthcare needs. Whether it was for routine checkups or acute health issues, the primary care physician was the single point of access to medical services, other than the exorbitantly expensive trip to the emergency room.
However, the industry-wide switch to value-based care has emphasized a paradigm shift toward putting the patient at the center of the healthcare ecosystem. As such, Marino explained at the HFMA conference that failing to offer patients convenient access to care is akin to begging them to find somewhere else to provide their health care services.
"Access becomes critical," Marino said, as quoted by Healthcare Finance News. "Hospitals and physicians are starting to align. The next thing is to engage consumers. Link them into your network so they do not want to leave. What is that cost of care? We need patients to stay in network."
"On-going care availability will reduce the number of redundant tests and interventions."
Of course, care access points cannot be created from nothing, which is why care coordination has become such a critical dynamic in the modern healthcare world. Aligning all members of an individual patient's stakeholder team into a vertically coordinated group will not only allow that person to seek and obtain services when necessary, but this on-going availability will also reduce the number of redundant tests and interventions, thereby reducing the overall spend for chronic patients who have the potential drive up costs, Marino explained.
Coordinate sooner rather than later
According to the Agency for Healthcare Research and Quality, many of the biggest roadblocks to coordinated care networks involved the holdovers of a fee-for-service healthcare model. Fragmented services like primary care and supplemental radiological or testing locations often require patients to navigate the gaps in care by themselves. However, as Marino told the HFMA conference attendees, technology has emerged as a solution to those previously insurmountable missing links.
"The successful [providers] that are out there are building systems of care," Marino said. "Technology and analytics, connected with care will reduce redundancy and drive down cost."
By moving patient health records onto a cloud-based system that reduces the burden of file sharing, patients can experience shorter wait times and more efficient care across the healthcare continuum. Whether they are seeking specialists in departments that are not traditionally connected to primary care services or waiting for results to transfer back to the physicians who require them before successive steps can be taken, technology is the bridge that links coordinated care.
While the costs to transition to a coordinated care network may be high, the future rewards may be too good to pass up, Marino explained. Initially, he stated that it may cost anywhere between $3 to $20 million depending on each individual provider's existing network, but initial investments dwarf in comparison to future dividends.
"It is not just talk about clinical integration as you set it up, you have to talk about what is next around value-based contracting," Marino said. "If you do a better quality of care with a patient, you will reduce costs."