Becker's Hospital Review

Executive Briefing: Value-Based Contracting 25 Unfamiliar ground is a setting to grow new efficiencies. Exploring chronic disease management outside hospital walls www.optum.com/journey cial incentive to coordinate care. "In this step, physicians can now be sufficiently reimbursed for taking proactive steps, such as outreach phone calls," he says. reform. This means organizations must focus on patients who have diabetes, cancer, acquired diseases and musculoskeletal diseases, Dr. Snowden says. 3. Expand chronic disease management within the ambulatory setting. However, it's not enough to merely direct these chronic disease patients to a physician's office. Often, these patients are not proactive on their preventive and wellness checkups, so hospitals and physicians pattern is seamless must use data and analytics to find these patients and use care manager outreach strategies to bring them into the office setting when appropriate, Dr. Snowden says. In 2012, Optum managed care for 5 million consumers and found, contrary to conventional wisdom, most healthcare costs are not incurred in the inpatient setting. Only 25 percent of costs were attributed to inpatient care, while the remaining costs were attributed to outpatient care and medications. "Managing care in the ambulatory setting is the most important thing that can be done in controlling costs in a population," Dr. Snowden says. "This is exactly the opposite of what most healthcare executives think." So what should hospitals and physicians do? They must invest heavily in managing the sickest population before they enter the hospitals—a key tenet of healthcare 4. Invest in in-home interventions for the sickest, post-acute population. A patient's home is the lowest-cost site of care, and the healthcare providers who are most successful under value-based models recognize this. Optum found that if a nurse practitioner or physician actively participates in the in-home care management of a Medicare patient, average acute-care admissions decrease by 64 percent—meaning the patient is in the right setting (and perhaps a more comfortable setting). "There is no such thing as investing too much money in putting clinical professionals in home for the highest-acuity people," Dr. Snowden says. "Providing care to the sickest 1 percent with the assistance of a nurse practitioner or a registered nurse or even a physician in a home setting on a regular basis instead of in an inpatient setting is an investment that pays off very handsomely for both the physician and the patient." Value-based contracting is an art in healthcare today, and often, these arrangements are more involved than the four outlined steps. However, Dr. Snowden says providers who have done well in valuebased contracting have focused on these areas—and all with the help of the right data analytics and predictive modeling tools. n

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