Value-Based Care to Soar in 2024

Donna White

Donna White

By Donna White, Principal Consultant and Owner of Legacy Consulting Services and Legacy Billing Solutions in Montgomery, Alabama.

Value-based healthcare is beginning its anticipated acceleration in 2024. This model is all about making sure patients get the best care possible while keeping costs in check in a tough healthcare environment. Instead of just paying for every service a patient receives, regardless of how effective it is, value-based care focuses on the outcomes of those services. So, if a treatment helps a patient get better quickly and stay healthy longer, that’s considered valuable.

Now, why is the VBC model picking up speed this year? 

Well, think about it this way: when healthcare providers are rewarded for keeping people healthy and out of the hospital rather than just treating them when they’re sick, everyone wins. Patients get better care, providers get better at preventing health issues before they become serious, and it even saves money in the long run. Plus, with advances in technology and more data available than ever before, healthcare providers can do an even better job of predicting and preventing health problems. So, it’s like a win-win-win situation, which is why value-based healthcare is taking off like never before in 2024. That’s why Legacy Consulting is prepared to help organizations take on this challenge.

To adapt to this significant shift from the traditional fee-for-service model, healthcare organizations are increasingly turning to advanced technologies.

In a recent blog from industry analyst Scott Lundstrom, the following technologies are driving the delivery of value-based healthcare:

  • Telemedicine
  • Artificial intelligence (AI)
  • Wearable health tech
  • Intelligent document processing

Is getting to the doctor’s office sometimes a hassle? Of course, we all know that especially since COVID. Telemedicine is changing that game. We can chat with our healthcare providers, undergo an exam, and get medical advice without ever leaving the couch.

Telemedicine isn’t just convenient, though. It’s also making healthcare more efficient and accessible. Telemedicine is part of a bigger picture called continuous care management. That means your healthcare team can keep tabs on you regularly, adjusting your treatment plan as needed and offering support whenever you need it, all through virtual check-ins and remote monitoring. It’s like having your own personal healthcare coach, right at your fingertips.

Artificial Intelligence (AI) and machine learning are shaking things up in healthcare. These cutting-edge technologies are like the superheroes of the medical world, especially when it comes to value-based care.

AI can sift through mountains of data to spot patterns and predict which patients might be at risk for certain health issues or need to return to the hospital. It’s like having a crystal ball that helps doctors prioritize who needs help the most, even before they show any symptoms.

But it doesn’t stop there. Machine learning algorithms are like super-efficient assistants, taking care of tedious administrative tasks like managing finances and processing claims. This not only speeds things up but also cuts down on mistakes, which saves time and money.

And here’s the kicker: AI-powered chatbots and virtual assistants are stepping in to help patients stay on track with their treatment plans. They can answer questions, remind folks to take their meds, and provide support whenever it’s needed. It’s like having a friendly guide along for the healthcare journey, making sure everything goes smoothly.

Wearables like fitness trackers and medical sensors are making healthcare smarter, personalized and more convenient for everyone. They give real-time health data to your docs, helping personalize care. For chronic conditions, they’re a game-changer, keeping tabs on your health and cutting down hospital trips. Plus, remote monitoring means less hassle and lower costs overall.

In just 3 years, the number of connected wearable devices worldwide went from 325 million in 2016 to 722 million connections! It reached over 1 billion in 2022 and is still on the rise. That’s according to numbers from Tech Report.

IDP is changing the game in healthcare. Picture this: instead of drowning in paperwork, IDP swoops in to automate all those tedious document tasks, like sorting patient records, processing insurance claims, and handling billing.

Why does it matter? For starters, it’s a huge time-saver. Say goodbye to hours of manual data entry and hello to more time for what really matters: taking care of patients.

But that’s not all. IDP doesn’t just make things faster—it also makes them smarter. By digitizing all those documents, healthcare folks can access everything they need. That means quicker decisions, faster responses to patient needs, and overall better care.

So, thanks to IDP, healthcare is getting a whole lot more efficient, accurate, and focused on what truly counts: the patients.

Legacy Consulting Services Strategizes the Transition to Value-Based Care

Our Legacy Consulting Services team brings together a blend of strategy, operations, and clinical know-how, meeting you wherever you stand on your transition from traditional fee-for-service to value-based care models.

The key is transitioning the mindset from prior success indicators and committing to quality and outcomes. One critical step is working with payors to move from fee-for-service agreements to value-based agreements and negotiating incentives. 

At Legacy, we work with each payor and practice management/EHR vendor to ensure analytics are available and used to drive clinical and financial decision-making. By analyzing data such as billing and coding, claims and reimbursement, as well as quality and outcomes, practices can identify areas of inefficiency and opportunities for improvement. 

If the analytics are not available by the payor or system, the practice will typically invest in business intelligence or predictive modeling software to assist. Our experts collaborate with all parties, including IT professionals, to ensure the infrastructure and analytics are capable of delivering the information necessary.

What is Risk Modeling?

As artificial intelligence has quickly ramped up, many health plans have turned to AI-based technologies to review patient records for critical details required to substantiate conditions.  

For instance, natural language processing can automate the manual chart review process, which has always been incredibly costly and labor-intensive. Going through thousands of pages of documentation to review pieces of data can analyze text that contains important information and can pull a diagnosis and CPT codes which can be mapped to HCC codes for risk capture.  

HCC stands for hierarchical condition category which is a risk adjustment model designed to estimate future healthcare costs for patients.  

By aligning financial incentives, payors and providers collaborate to manage costs and improve patient outcomes. There are several models, such as Pay-for-Performance (P4P), shared savings, Medicare Shared Savings Program (MSSP), Accountable Care Organizations (ACOs), downside risk, bundled payments, capitation, and delegation.  

  • Providers must decide what level of risk they are willing to assume and must understand their patient population. 
  • Being aware of the size of their patient panels is also important in determining the level of risk they are comfortable taking on. 
  • Having an understanding of historical performance is also important.  

Value-based care has risks, but also rewards, enabling providers to align financial incentives to better outcomes.

What About Comprehensive Strategies?

At Legacy Consulting, we offer services to educate providers on the benefits of Value-based care.  

We work with payors and practice management/electronic health record vendors on their behalf to ensure the contracts and systems are set up to effectively implement this program. Collecting relevant patient data to perform accurate data analysis and implement this strategy with the right mix of policy, people, and technology is critical. Modeling advanced arrangements using past clinical and financial outcomes is important. It is a two-pronged approach, looking at savings on the total cost of care (TCOC) while assessing what revenue losses may occur.  Contact Legacy Consulting today so that we may develop an implementation strategy, provide data analytics expertise, and work with you to improve patient outcomes, control costs and provide high-quality healthcare to patients.

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