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The key role of care groups in value-based care


The value-based care program dates to 2008, with the launch of the Medicare Improvements for Patients & Providers Act (MIPPA). Since then, the move toward value-based care has been focused on providing higher quality care that results in improved outcomes. Providers are rewarded for these outcomes rather than reimbursed for the quantity of patient encounters. The key role of care groups in value-based care is evident in population health management, one of its main components.

The Centers for Medicare & Medicaid Services (CMS) states that value-based programs are designed to reward healthcare providers with incentive payments for the quality of care they provide. The CMS programs are part of the larger quality strategy to reform how healthcare is delivered and compensated. The three-part aim of value-based care focuses on:

  • Lower cost
  • Better care for individuals
  • Better health for populations.

Research into healthcare organizations that have achieved these higher quality outcomes while lowering costs “suggests a strategic framework for value-based health care implementation that starts with identifying and understanding a segment of patients whose health and related circumstances create a consistent set of needs.” The team of healthcare providers then comes together to design and deliver a comprehensive solution to addressing those needs in a value-based approach.

When healthcare is provided in this integrated, coordinated approach, it aligns to how the patients experience their own health. It also reconnects the providers to their intended purpose as healers. As part of a larger care group, physicians can think differently about their role and about the services they provide.

Healthcare providers and care groups are viewing quality care from a different perspective as the value-based movement continues to trend. Providers now take a team-based approach to their patients’ overall care, focusing on the whole person and not just a specific condition that the patient may experience at any given point in time.

True value-based requires the healthcare provider to have insight into the characteristics of their individual patients as well as the larger population. Enabling that comprehensive, coordinated care is one way that care groups play a key role in improving the patient outcomes.

Delivering coordinated care efficiently means eliminating data silos and unleashing the power of information available through analytics. Communicating between providers and between providers and patients is also an important aspect of coordinated value-based care.

Aspects of value-based care in which care groups play a key role include:

Interoperability: Comprehensive patient data that includes information about social determinants of health is critical for healthcare providers to provide value-based care, particularly in regard to improving population health. Access to this data is possible when information systems are integrated, enabling providers to care for the whole person rather than reacting to a single condition.

Patient engagement: Technology platforms such as electronic health records (EHRs) and patient portals enable healthcare providers and patients to communicate seamlessly, encouraging patients to become more involved in their own care, taking a more positive and proactive approach to their health.

Analytics: Predictive and prescriptive analytics are essential for identifying potential patient risks in real time. Within the care group, analytics can process hundreds of predictors culled from claims, EHRs, and self-reported patient data. Using the power of the group and advances in analytic technology, healthcare providers are better able to plan for and deliver the value-based care that will result in improved outcomes for their patients.