Value-based care models are said to represent “policymaking at 80,000 feet.”
Healthcare leaders who were once optimistic about value-based reimbursement models are becoming doubtful after seeing the performance of several programs. Accountable Care Organizations (ACOs) are achieving modest gains and a meager 28% of Medicare Shared Savings Program (MSSP) participants have generated cost savings.
However, it may not be time to throw in the towel on value-based care. Success is expected to take many years. As practices “gain more experience, their quality and cost-savings performance improves,” says Hospitals and Health Networks (H&HN) magazine. Furthermore, the magazine reports that recognizing opportunities for partnership or collaboration is one of the best factors for success.
Successful value-based care coordination examples
Despite a shortage of evidence to prove the value of value-based care models, there are a handful of success stories. And enhanced care coordination, including referral management, has proven to be a common trait.
Triad HealthCare Network, a North Carolina medical group, had their success spotlighted by H&HN magazine for their achievement of $22 million in Medicare Shared Savings Plan (MSSP). Triad received shared savings in their first two years by “managing a population’s health across the continuum of care, not just providing fragmented point-of-care services.” Another successful group, Henry Ford Physicians, generated cost savings by creating a support team to better coordinate care throughout the system for 20,000 Medicare patients in southeast Michigan. 30% of Henry Ford Physicians’ business is now value-based.
Another population health management success story is detailed in a case study published in Family Practice Management. In the study, a multi-specialty group that hired two care coordinators decreased no-shows and hospital readmissions, while increasing visit volume and revenue, and most importantly, improving patient outcomes.
One care coordination and referral management success story comes from Health Affairs. The publication described how one healthcare organization looked at its referral patterns and noticed that its different physicians’ referral rates were the main culprit in causing huge variation in its patients’ orthopedic surgical rates.
Successful care coordination with referral management
Successful care coordination tactics represent the new era of value-based care. An era where leading primary care leaders need tools such as electronic referral management applications to closely coordinate care with their specialty partners. With referral management, PCP practices are no longer blind about their physicians’ referral trends, which leads to enhanced coordination of care.
Electronic referral management also tracks patients at every step of the referral process and allows practices to evaluate the referral performance of their specialists. Features like these ensure smooth transitions of care and increase opportunities for practices to close more referral loops more often.
A report prepared for the Centers for Medicare and Medicaid Services (CMS) concluded that practices that “place more emphasis on engaging providers through...referral management activities” are better positioned to achieve cost savings. Success may take a few years, but better care coordination with electronically connected referral partners can start now.