How Practice Groups Are Evolving in the Age of Value-Based Care

The healthcare landscape is shifting — fast. Today’s practice groups and skilled nursing facility operators need solutions to successfully navigate the shift to value-based care. Making the leap isn’t just about changing contracts — it’s about transforming the way care is coordinated, risks are managed, and success is measured.

Recently, our own Anthony Laflen, Vice President of Senior Care, Value-Based Care for PointClickCare, and Tom Haithcoat, Vice President of Government Affairs, CareConnectMD and President of Ceptor Consulting, sat down with McKnight’s Long-Term Care News Market Leaders podcast to discuss the transition from fee-for-service healthcare to value-based care models.

Value-Base Care is Measured Differently

The metrics for success in value-based care models are distinct from those in fee-for-service models. Anthony Laflen discussed how the metrics are really categorized in three areas: cost and financial performance, followed by the patient outcomes and a focus on quality measures, and operational efficiencies and engagement. He highlighted the importance of understanding the total cost of care and trimming unnecessary expenses to create savings and opportunities.

Success in Value-Based Care is About Selecting the Right Model

Choosing the appropriate model for the specific patient cohort is essential for success in value-based care. “There’s a narrower number of accountable care organization (ACO) related and risk-based models that are designed specifically for post-acute care,” explained Tom Haithcoat. He emphasized that “You pick the right model, and then you can start talking about behavioral changes that need to be made to be successful in that model.” Anthony Laflen echoed this, stating, “Fundamentally, you need to be comfortable with moving away from a volume approach to a value approach.”

Haithcoat also highlighted the importance of aligning incentives and working collaboratively. For example, he noted that a meaningful conversation about a patient’s code status can result in a 50% reduction in expenditures. Having a patient who understands where they are and what chapter of their life they are in can significantly impact costs and quality of care.

Early Intervention and Proactive Care are Critical

Early intervention and proactive care are key elements in value-based care models to improve patient outcomes and reduce costs. “Early interventions are probably one of the most elemental things that you need to be focused on,” Laflen said. He stressed the importance of leveraging real-time data to identify changes in a patient’s condition and intervening promptly. “When you do this accurately, you drive down expense, you create opportunity for yourself and for the model, the risk bearer upstream.”

Haithcoat further explained the importance of continuous engagement and disease management: “When you’re looking at that level of engagement, it’s no longer a metric to try and engage the beneficiary, that’s not the problem. The problem is, is they’re very high acuity, and in a setting that can seem fragmented or misaligned.” He also noted that metrics like hospitalization rates and emergency reutilization are critical for post-acute care settings, as they can significantly impact costs and patient experiences. “By increasing frequency, the physician practice can stabilize finances while they’re participating, and then the gain share is truly an incentive on the back door,” he added.

Real-Time Data is Essential

Real-time data and technology play a pivotal role in the success of value-based care models. “Success is really no longer tethered to how many procedures you’re doing, but more about the improved patient outcomes,” said Laflen. He emphasized the need for a data-driven mindset, particularly real-time analytics, to identify high-risk populations and intervene early. “You’re going to want to identify those high-risk populations, see that change in condition happen in real time, and then intervene,” he added.

Laflen also discussed the importance of leveraging technology to support these efforts: “PointClickCare has made the investment and began to develop a best in class EHR for a practice group, something that is directly tethered to that source of truth.” This technology ensures that frontline staff can engage proactively and mitigate unnecessary expenses, which is crucial for both financial and patient outcomes. “It ensures that you’re taking a practical and a profitable approach,” he stated.

Plotting the Way Forward

As healthcare continues to evolve to a value-based model, practice groups must become even smarter, more efficient, and better collaborators to ensure they’re able to care for their patients. By putting in place systems that improve the way care is coordinated, risks are managed, and success is measured with real-time data and cross-discipline communication, it’s all possible.  

To learn more, listen to the full podcast episode here.