Value-based care: Six steps to prepare

April 1, 2015

Are you ready for value-based compensation? If not, these 6 steps can help you prepare.

Are you ready for value-based compensation? If not, these 6 steps can help you prepare.

1. Be in the know

It’s vital that urologists turn their attention to what’s going on with health care payment models at state and federal levels, according to Jeffrey Frankel, MD, of the American Association of Clinical Urologists.

RELATED: Say farewell to fee for service

 “Look at all these proposals. It’s critical that urologists know what their local healthcare systems are planning. They have to stay abreast of the accountable care organizations in their areas. They have to look at insurance programs. They have to pay attention to health policies,” he said.

2. Look at how your practice fits into the big picture and work at becoming a better fit.

High-cost practices will become outliers in the new paradigm, experts say.

Urologists should understand how they fit into the local landscape of care, regarding value and cost, and make changes where needed to better position themselves for contracts.

“I think we’re in a window right now,” said Doral Jacobsen of DHG Healthcare in Asheville, NC. “Make sure when you’re renegotiating your contracts that you’re asking your payers to start paying you for value; otherwise, that window is going to close. So, for example, fast-forward 3 years: If you’ve already been incentivized to manage your pharmacy costs very aggressively, there’s not going to be a big spread there. We’re already doing these things for Medicare; why not expand that to the commercial payer market?”

NEXT: Partner (yes, partner) with payers

 

3. Partner (yes, partner) with payers

Urologists should ask their payers to provide information about quality metrics and how to meet them, according to Jacobsen.

“We suggest not only asking for it in written form but asking the payer to come meet with you and explain it, because it’s a little cryptic and difficult to discern, and worthy of an in-person discussion,” she said.

4. Develop a value proposition

Urologists should determine what procedures and services make their practices stand out and communicate their successes.

“Do you have great patient satisfaction ratings? Are your infection rates beating peer groups? What about readmission rates?” Jacobsen said. “You really have to tell that story to the payers, so they can understand the value that you bring to their networks.”

5. Look at bundling

“A lot of specialties are looking at bundled services and marketing those to partners-ACOs, IPAs [independent practice association], or other medical groups. It’s about driving volume. If you can provide the services at a reasonable cost with high quality, driving volume can make a bundle work,” Jacobsen said.

NEXT: Consider aligning with a bigger group

 

6. If you’re in a small practice, consider aligning with a bigger group

In new payment models, urologists could be penalized without doing anything wrong, according to Dr. Frankel. In other words, a smaller group might have the quality of care but no ability to show payers.

Finding ways to deliver the needed data to entities that are asking for it is a concern, Dr. Frankel says.

“I’m part of a three-person practice, and it’s one of our big concerns,” he said. “It might require that we re-engineer the whole practice.”

The best way a small group urology practice can prepare for the transition away from fee for service, according to Gary M. Kirsh, MD, of LUGPA, is to become part of a larger group.

“If a doctor wants to remain independent, they’re going to have increasing difficulty navigating this environment on their own. So, they’re going to have to associate themselves with an entity that can do it,” Dr. Kirsh said.

And LUGPA can help, according to Dr. Kirsh.

“Our organization is also embracing smaller urology groups to be members, so that we can help them navigate this future, as well,” he said.

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