Value-Based Care: Managing Processes to Improve Outcomes

This module is an introduction to and exploration of critical office-based processes a value-based practice must manage in the drive towards improved patient outcomes, a primary VBC tenet. In managing patients in a healthcare system, the targeted processes include: Patient-Centered Medical Home, preventive and screening services, annual wellness visits, managing acute needs via an open access model, quality of care metrics, coding to support enhanced coordination, and staffing. Managing office processes plays a key role in this strategic pursuit. From information retrieved from annual screenings to how the office is set up, every patient visit is an opportunity to identify and address a healthcare issue. This is what physician offices want to do and should be thinking about; besides, patients always prefer to handle problems in the office rather than in the hospital. However, managing processes is not the responsibility of one person. It is a team effort, requiring input from all team members. To improve outcomes, all team members have critical roles in designing, implementing, and refining processes. At the end of this module, you will explore a fourth dimension related to staffing that, when added to the Triple Aim, creates the Quadruple Aim.

This module is designed to introduce you to the office-based and clinical patient-based supporting functions that, when managed collectively, lead to improved patient outcomes. These include: 1) Medical Management: Utilization, Case, Data and Pharmacy, 2) Registries, Analytics, and Technology, 3) Guidelines, Types of Evidence, and Recommendations, and 4) Coordination around SDOH/Community Resources. The world of primary care medicine is evolving rapidly. Patient expectations are changing, along with those of third-party payers and the providers themselves. Many patients are looking for “on demand” access, but others are looking for a long-term medical home. Telemedicine and telehealth are growing along with new approaches to hospital- and home-based functions. These changes all point to the idea that patients and payers are looking for value. And that “value” is not just an appointment and a paper prescription to fill at the end, but real assistance to manage chronic diseases and help patients navigate the complex world of the healthcare system. Discussion of those additional office-based supporting functions will comprise the majority of information in this module. In addition to those patients who come in for appointments, maintain regular healthcare visits, or become hospitalized, a big part in the role of supporting functions is to capture the health status of patients who have not visited in six months to a year. Utilizing panel management—a systematic, proactive approach to identify and address unmet chronic and preventive care needs of the patients a practice is responsible for—leads to better health outcomes for that patient population. Whether an office has insurer-based reporting or uses office-based record-keeping, using panel management to ask clinical patient-based questions related to immunizations, cancer screenings, or diabetes care is using the function of data/predictive analytics to support a strategy of identifying non-utilization patterns. Remember, as you read or hear terms or concepts that are new to you, have your digital (Word doc) or analog (paper) notepad handy to write them down. At any time, you can use your favorite search engine to learn more. Be a self-directed learner!