Putting Quality First: The Shift from Volume to Value in Delivering Healthcare

In healthcare, since the late 1990s, one of the most significant shifts in focus on quality care was the pivot away from fee-for-service volumes measured quality of care. We are beginning to see value-based care replacing the pay-for-performance model. Now, performance improvements are evaluated by quality compliance measures in conjunction with the management of medical costs. 

The healthcare system continues to transition from payers reimbursing providers based on the number of services provided to reimbursing based on the quality of the care and rewards efficiency and effectiveness in healthcare delivery. Under this” value-based” payment model, quality of care is measured by more affordable costs, process improvement, provider training on value-based healthcare, survey readiness, a cultural backbone of open communication, standardized reporting, and validated data sharing with front-line professionals, among other requirements. 

The value-based model builds strong relationships between quality and clinical outpatient care. The success of this care model is dependent on patient involvement. It is reinforced by providing patient portal access, health literacy education, and patient activation, which engages patients in shared decision-making and the ability to self-manage illness, participate in activities that support a healthy lifestyle, and involvement in treatment and diagnostic choices. 

Understanding this, providers must continue their efforts to bolster patient engagement and better position themselves to address the health needs of their patient population, particularly in underserved communities. 

At AdvantageCare Physicians (ACPNY) – one of the largest primary and specialty care practices in the New York area – we have implemented this care model at over 30 medical offices across the five boroughs and Long Island. We collaborate with communities and stakeholders to align all our efforts with one priority: the patient. 

Some of the strategies our practice has implemented to positively impact patient health outcomes include:

● Electronic Medical Record (EMR) investments

● Patient-Centered Medical Home (PCMH) Recognition

● Ongoing provider and care team training

● Proactive outreach to engage patients regarding their care:

● Digital outreach through a patient portal

● Telephonic outreach to a patient's home

● In-person outreach at community events

● Monitoring patient experience to provide improvement feedback

● Creating and enhancing workflows that support new government initiatives, such as: 

● Chronic Care Management

● Healthcare Effectiveness Data and Information Set (HEDIS)

● Social Determinants of Health (SDOH)

● Sexual Orientation and Gender Identity (SOGI)

AdvantageCare Physicians has invested and continues to invest in proactive outreach efforts to engage our patients. We have assessed outreach requirements through chart review and applying HEDIS specifications with chronic care management. This approach helps ensure that primary care visits and appropriate screenings are scheduled to meet our requirements with our value-based payer partners. 

Through proactive, consistent outreach, as well as digital and telephone communication, we have seen increases in patient engagement, resulting in 91% of our Medicare population and 70% of our Medicaid population being seen for a primary care visit. Notably, the most tremendous gains have been with our patient population in the 65+ age group. At our practice, approximately 70% of our patients have an active patient portal account, which contributes in part to the overall success of our patient engagement strategies.

Aside from proactive outreach, it is also essential for providers to develop effective working relationships with their value-based payer partners to understand their work's impact on cost management and to continue to increase the standard for quality of care. In doing so, you can leverage information gathered through meeting cadence with payer partners to implement changes that will support cost management without sacrificing quality of care.

The transition from a fee-for-service model to a quality-of-care or value-based care model continues to present challenges. With what appears to be a tapering of the COVID-19 epidemic, fear and broader economic challenges have created new barriers for patients seeking and receiving care. COVID broke the flow of patient engagement, creating reluctance in patients' openness to schedule in-office visits. 

However, trends continue to show an uptick in patients returning to our offices, which is excellent news for care coordination and opportunities to improve their quality of life. Healthcare is ever-evolving, and we as a provider group must keep pace with the changing times by strategically identifying ways to meet quality standards and make impactful inroads with patients.