How To Financially Optimize Value-Based Care: Part 2

Financial optimization looks a lot like technology optimization.

Value-based care may sound great, but as providers know, it takes a lot of savvy coordination to make it work.

To successfully manage the financial transformation, CFOs will need to use tools like data analytics and artificial intelligence (AI), while fostering consistent collaboration between payers and providers.

AI & tech investments for holistic care

HFMA Senior Vice President for Content and Professional Practice Guidance Rick Gundling says it’s important for CFOs to look at what types of technology investments are going to make the difference for patient care, under a holistic care model.

 We know the impact AI can make in the hospital, from clinical note-taking, to data extraction, to diagnostics. But AI can also help fill in the gaps by monitoring the patient before, after and in -between care visits.

Additionally, AI can go further than simply just asking a patient if they took their meds today. Think of AI and other tools as being used to address things like food scarcity and mental health by pointing patients towards the right resources in their community.

As discussed in part one of this story, providers need to be a strong community partner, and that means looking at how the health system is involved with its neighbors, from food-drives to exercise programs to health education classes. How providers invest and spend time in their communities will inform how they structure their value-based care models.

CFOs should explore AI solutions that integrate seamlessly with their existing systems, ensuring the smooth exchange of data across platforms and departments. AI can also help monitor and optimize the ongoing performance of value-based contracts, making it easier for CFOs to identify areas where financial adjustments or changes to care protocols need to be made.

The duty of data

Providers must get better at extracting the right data, and this goes further than just having a robust electronic health record. A big driver of the messiness in value-based care is the exorbitant amount of data required to make it work well. While data access isn’t usually the challenge, extracting the right data at the right time, as well as aligning that data, is crucial. This is where AI can lend a hand so providers don’t get overwhelmed with large datasets, like population health metrics.

Allison Foster, director of Value Based Care at SCAN Health Plan, says she knows VBC can’t work without the right data and the right approach. As a former implementation project manager at Epic Systems, Foster knows that VBC can’t succeed without it.

“I think the biggest piece to all of this is data sharing and analytics and transparency,” she says.

Much of her work at Epic revolved around interoperability functionality, she says, and ensuring that when a patient is admitted, their records are easily accessible in different locations.

“I think when it comes to general value-based care, you can only do it if you have the whole patient story in front of you,” she says. “So I think the biggest tension that you see in value-based care is that different parties [in] these conversations and these contracts have different data.”

The CFO's data strategy must be two-fold. They must collaborate with CTOs to make the right investments in data analytics that will align with the health system’s current care model structure. Next, they must ensure the payer and provider are using the same financial data that influences contracts.

“I think the biggest headache for providers and for payers is making sure you're not building just administratively complex bureaucratic systems,” says Foster. “What you ultimately want to do is incentivize high-quality care.”

Collaboration from all angles

Gundling says the foundation of value-based care is figuring out how to do less, while creating more. When providers figure out how to conduct less-expensive and less-complex care, it allows the system to see savings.

“Providers are the best people to decide what happens for their patients, rather than a health plan,” says Foster. “So when you talk about global capitation, you're giving them all of the dollars that they need to decide where that should be spent and spend it on what they think matters most for those patients.”

When payers, providers, and the patient are saving on cost, that’s what makes the model sustainable, says Gundling. Consistent collaboration is vital.

Setting up a health system’s financial system for value-based care is no small task. But CFOs have the knowledge and expertise to do it. CFOs must foster trust and collaboration both in and out of the health system and prioritize internal relations with their staff, both clinical and executive.

Looking at the cost of care per patient per month is a critical measurement, and one clinicians should be aware of too, says Gundling. CFOs should be able to collaborate with clinicians on the financial impact of their care decisions.

“I think the CFOs need to be almost internal consultants as well,” says Gundling.

They also must be consistent in their collaboration with payers, ensuring data, strategies and financial incentives are all aligned.

“Value based care models sort of force payers and providers to collaborate with each other and really think about designing a care model that isn't just incentivizing how many times someone goes to the provider office,” says Foster.