Referring to COVID-19 as the “100-year pandemic,” as if to suggest we should, in some small way, feel fortunate it doesn’t happen more often, does little to lessen the devastation and disruption it has left in its wake while enveloping the world. Although there are now signs of slowing, the pandemic has exposed beyond a doubt the weaknesses of fee-for-service (FFS) reimbursement that U.S. healthcare is so dependent upon. The level of disruption has thrown off the delicate balance between profitable FFS activities and revenue-anemic inpatient admissions, especially the ultra-expensive intensive care unit (ICU) stays. Layer in the added cost of personal protective equipment (PPE) supplies, physical capacity expansion, and staff resource support, the entire care infrastructure has been overwhelmed physically, emotionally, and financially. The human toll has been immense, not only on direct lives lost to date [and continuing to rise], but to the future impact on the survivors, the families, the front-line providers, and the millions of patients who have foregone care. Financially, based on conservative, early pandemic estimates, healthcare systems will have lost nearly half a trillion dollars by the end of 2020 leading to tens of thousands of “less critical” workers being furloughed, and hospitals closing or declaring bankruptcy. There are many systemic healthcare lessons being written about this pandemic, but the one that requires a remedy from our collective wherewithal is how we prevent this from happening again.
Fortunately, there have also been many positive learnings that have emerged from the pandemic, including the rapid movement to [and payment for] certain value-based care delivery processes, e.g., virtual visits, which may well serve as the initial inoculations necessary to avert a similar fate down the road. Further evolution of these and other care delivery and payment innovations should remain a priority, both out of current necessity as well as future preparedness in the eventual move toward less and less reliance on FFS reimbursement. As difficult as it may feel, now is the time to capitalize on the tools and capabilities that will inevitably help us succeed in value-based care. In a not-too-distant world where the focus of healthcare gradually moves away from high-cost hospital centricity and more appropriately onto the shoulders of ambulatory and post-acute care, we must take advantage of current positive population health financial returns and be the drivers of future pay-for-outcomes models that will eventually sustain an appropriately scaled healthcare system.
Here are a few examples:
- Reach out to Medicare FFS and Medicare Advantage patients to complete their Annual Wellness Visits (AWV) and appropriate follow up services
- Create office processes to ensure appropriate coding and documentation to garner deserving financial credit for the sickest patients that require more care intensity
- Dedicate a team member to ensure quality and satisfaction pay-for-performance measures are at or above contractual targets
- Initiate or expand the team’s care navigation skills to stratify patients, and manage high complexity patients at financial risk
- Maintain or expand an appropriate level of telephone and video visits yielding to patients’ preferences and conditions
- Lead payer contract negotiations toward risk arrangements where you’ve created effective population health capabilities, e.g., care navigation, appropriate use best practices
While these initial value-based care steps may not seem transformative, they can enhance revenue with little investment and achieve better outcomes for patients. Over time, bolder steps in care delivery will be needed, in collaboration with payers, moving progressively toward more downside risk. With this experience, providers will be more confident in aligning terms of payer contracts that will ensure their own financial success.