Organizations are more frequently choosing to adopt value-based care (VBC) models because of their ability to improve patient outcomes while controlling costs. But shifting to this type of care model involves significant time, financial, and staffing investments that are difficult for many healthcare organizations to make.
Before taking steps to implement a VBC model, organizations must first understand how prepared they are for the shift and what challenges they could encounter on the way. Without adequate planning, providers may fail to realize the expected return on investment (ROI) from value-based care.
The Challenges of Implementing a Value-Based Care Model
These are a few of the most common challenges that organizations encounter on their road to VBC:
Financial Uncertainty
Value-based care requires substantial upfront investments in technology, data analytics, and care coordination infrastructure — all of which have uncertain ROI timeframes. Moreover, frequent policy changes have made it difficult for healthcare providers to develop stable, long-term strategies for VBC implementation. For example, since 2012, the Center for Medicare & Medicaid Services (CMS) has continuously introduced and revised regulations and policies for VBC incentive programs, creating uncertainty and inconsistent outcomes. Navigating frequent policy shifts can result in hesitation from providers to dedicate significant financial resources to VBC, despite VBC’s potential to help improve patient care quality and manage costs over time.
Provider and Patient Resistance
Because most provider revenue cycles are based on fee-for-service methods and clinicians have practiced them for decades, they may be resistant to shifting to a new financial model. Widespread provider skepticism about whether qualitative metrics like patient engagement scores and reported outcomes capture meaningful clinical outcomes or patient experience also pervade the industry. For example, if an academic medical center is trying to implement VBC, department chairs may be worried about revenue loss while clinicians are questioning the validity of the associated quality metrics.
Patient alignment also presents a challenge, as they may have limited health literacy or trust in healthcare — neither of which is conducive to VBC’s patient-empowered approach to care. In many cases, patients are accustomed to seeking care only when they are sick, so it may be challenging to convince them to seek regular preventive care.
Data Integration
Healthcare organizations have massive amounts of data across practices and electronic health record (EHR) systems. Their numerous clinical and administrative systems typically aren’t designed to communicate with each other, which can create data integration challenges across the organization. Given data access is essential to informing VBC program design, implementation, and ROI measurement, data integration issues can often prevent VBC success. For example, if a healthcare organization fails to integrate data before the shift to VBC, it may be unable to show the ROI either financially or in terms of patient care and access. This could result in a lack of buy-in across the leadership team for continuing the VBC program.
Staffing Constraints
Value-based care models require care coordinator, data analyst, and quality specialist roles that under-resourced organizations, like rural hospitals, often can’t fill or afford. Issues like slim margins and high competition for talent pose challenges for large systems as well. For those that can fill technical roles, these types of positions often lack the necessary authority to influence physician behavior and clinical practices. This disconnect can significantly undermine the effectiveness of VBC initiatives and slow implementation progress.
Setting Yourself Up for Success
The shift to value-based care is daunting and many healthcare leaders struggle with determining how to get started.
Understanding what resources you need and what gaps your organization needs to address is the first step in determining how to approach your shift to VBC. A VBC readiness assessment can help healthcare organizations gain this knowledge and determine how to leverage their strengths to achieve successful implementation.
With the right preparation, healthcare providers can make meaningful shifts to deliver high-quality patient care.
Is your organization planning a shift to value-based care? Take our readiness assessment to understand the next best step in your VBC transition and to receive your guide to navigating the shift to VBC.