Defining the Provider’s Role in Value-Based Care

Defining the Provider’s Role in Value-Based Care

September 22, 2017 Blog, managed care, value-based care 0 Comments

Defining the Provider’s Role in Value-Based Care

Moving to managed care can change workflow but create new opportunities for providers

Moving to value-based care means changes for all parts of the behavioral health organization. When an organization moves to value-based care, it is usually clear that providers are a critical part of reimagining the work. But what are the necessary changes? The general idea of change can feel scary to us, especially if we don’t have all the information or we don’t have control over the change. Providers are an essential piece of making an effective transition to value-based care, and successful transitions depend on a strong provider-executive team partnership.

In a webinar series that Qualifacts hosted through Behavioral Healthcare Executive, we looked at the roles that providers, finance, and the C-team play in transitioning to value-based or managed care. Our first webinar looked at the role that providers play in scaling the managed care mountain.

When an organization transitions to pay-for-performance or managed care contracts, three aspects of those contracts impact everything from provider-client interaction to clinical workflow to payment methodology to population health:

  1. Performance measurement
  2. Incentives and/or penalties
  3. Transparency/consumer engagement

This triad represents the core of how value-based care differs from the traditional fee-for-service model, where a provider offers a service, and then receives payment for that service. Value-based care focuses on measuring and rewarding the true value to the consumer—so it’s right in line with the evidence-based practices and standards of care that many organizations already incorporate into their clinical work. At the same time, value-based care calls on providers to analyze their work through metrics and outcomes, and to ensure their services truly provide benefit to the clients they work with.

Metrics Used in Value-Based Care

Four different kinds of metrics are commonly seen in managed care contracts. Some of them impact providers directly, but providers should have a clear understanding of all four kinds of metrics, because all of them affect the client experience, or the viability of the behavioral health organization.

  • Process metrics: How many of what kinds of interventions have you provided to how many clients? Are services provided in the appropriate time frame? Can you demonstrate that care is effectively coordinated with other providers when appropriate?
  • Outcomes metrics: Do we see improvement over time in individuals and populations?
  • Utilization metrics: Are resources used appropriately? Are the right types of staff managing the most appropriate types of interventions? These can relate to process, as well: How do providers spend their time? Is each staff member spending time on the most appropriate activities?
  • Patient satisfaction metrics: Are clients satisfied with their experience with staff and information access, with their access to care, and with their care?

The Provider’s Role in Value-Based Care

As an organization is transitioning to a managed-care contract or value-based care, providers should be a critical part of the team. Having provider input and leadership in several areas will ensure the success of a new way of working and serving clients.

In a transition to value-based care, providers need:

  • To be part of the team that selects metrics or measurements that will be evaluated. Your organization’s full team needs to understand how particular metrics reveal success in providing service, and understand what barriers stand in the way of achieving goals related to those metrics.
  • To have a voice in selecting and customizing the tools they will use to receive, evaluate, and manage data. When technology decisions are made in a vacuum—with just cost or technology driving the decision—they run the risk of failed implementation when providers actually begin working with the tool. No one can afford for that to happen, so it’s critical to put together a multi-disciplinary team on the front end.
  • To have at-the-ready access to data to make the best decisions for each client. Note that a provider doesn’t have to be the one to collect the data—and in many cases, this is a shift for behavioral healthcare organizations. To ensure profitability and appropriate utilization, many organizations will need to update the clinical workflow, so that other staff members collect data, or so that the client self-reports data. Then, a modern EHR ensures that all the data is available in the moment when the provider meets with the client.
  • To assess progress against metrics they have selected for each client. The tools that are required for value-based care data collection and assessment give providers a very different view of each consumer, and of the entire population. Over time, providers will gain significant insights into the care they provide.

More on Providers and Managed Care

Want to hear more? Listen to the whole webinar on the provider’s role in scaling the managed care mountain, and learn how executives, finance, and providers can partner for an effective transition to value-based care.

PART 1 |  The Provider’s Role: Scaling the Managed Care Mountain


If you like part one, you may also be interested in the other two webinars in this series:

PART 2 |  Finance’s Role: Scaling the Managed Care Mountain

PART 3 |  The CEO’s Role: Scaling the Managed Care Mountain