Health Care delivery has been forever changed by the COVID-19 pandemic. Although the challenge was met with great heroism, the public health crisis spotlighted the limitations of health care delivery. Health care systems scrambled to implement virtual technologies and create new channels for patient outreach while having to develop new strategies to manage social determinants and health equity. There is now a growing realization of the need for new capabilities, value-based care models, and innovation in patient care.
As a value-based care organization, CHESS Health Solutions has developed efficient care delivery channels for patient outreach that extends beyond practice locations. This proven infrastructure was crucial for communicating accurate and meaningful information to patient populations when COVID-19 became a crisis.
Value-based care payment models allow for sustainable and effective care, supporting the most vulnerable patients. This model has been incredibly effective during this time of great uncertainty and anxiety, and value-based care teams are a crucial component in that care. High-touch patient outreach and follow-up by the care teams is a successful approach. This has been proven time and again through increased medication adherence and diabetes quality measures performance. Prior to the pandemic, care team/patient relationships were fostered and trust was earned. This allowed the care team to be a reliable source to the patient for accurate and relevant health information when the pandemic hit.
The Role of Value-Based Care Teams
This ability to quickly pivot and meet the unique challenges of COVID-19 was due to CHESS’s prior experience in value-based care. In the early days of the pandemic, the CHESS value-based care teams, which include care coordination and pharmacy, informed patients of potential signs and symptoms of COVID-19. This information also included reliable information on screening options, PPE, and access to food and medicine.
The teams then worked to ensure that patients had access to virtual visits, including chronic care and annual wellness visits. Care teams also procured home health services and durable medical equipment and began proactive outreach using the electronic frailty indicator to allow the most vulnerable patients to reengage with chronic care follow-up once provider offices began to reopen.
The pharmacy teams identified patients at risk of being without necessary medications. The team worked to ensure that patients were able to access necessary medication to keep medication adherence on track. Through this work, pharmacy adherence measures are now on track for 4- and 5-star performance for 2020.
Managing Decreased Health Care Utilization
The pandemic caused a decrease in both acute care and outpatient utilization. Because of the potential threat of exposure and illness from COVID-19, self-isolation protocols, and limited access to providers, many patients were unwilling to seek care for non-COVID related health issues.
This drop in outpatient utilization caused concern about the deferral of chronic care and preventative screenings. Although initially causing great concern about performance on quality, early projections in our 2020 value-based agreements indicate that we will see another year of 4 – 4.25 STAR performance, consistent with the pre-pandemic care environment in 2019. Despite the unique challenges of COVID-19, our teams have been flexible and adaptable in ways that allowed consistent overall performance year over year. These positive indicators reflect the work of the value-based care teams.
The Importance of Increased Savings
Value-based care payment models can provide the opportunity for additional predictable revenue streams. This can be especially true in population-based payment models. The gain-share and risk arrangements in which CHESS is participating allow health systems to recoup costs of decreased utilization by increasing the savings generated within these contracts.
The COVID-19 pandemic makes a strong case for value-based payment models. This crisis highlights the need for a willingness on the part of health systems to commit to preparing for these models. This should be done by bringing together a high performing group of providers who understand and model successful value-oriented behaviors and then building the necessary infrastructure to support them.
Watch CHESS Chief Clinical Officer Jesse C. James, MD, MBA describe our Care Coordination and Pharmacy Hubs and the impact they have on the patient and benefit to the provider.