Busy primary care provider (PCP) practices need much more than an EMR and payer reports to thrive in a value-based care (VBC) environment. Physician practices and payers have begun the journey of transforming from fee-for-service business processes to VBC processes. As this fundamental change process matures, organizations will need more than analytic tools and reports to realize the full potential that VBC approaches represent to improve health outcomes and patient satisfaction and ultimately lower costs.
Primary care practices, in particular, need integrated processes and management systems across their operations that include clinical, operational, consumer and financial data analytic capabilities in order to effectively manage the business of healthcare while continuing to focus on delivering patient-centered care.
Many mid-to-large sized provider organizations that are transitioning to advanced, higher risk VBC models are faced with a stark reality: most payers do not have the care delivery expertise, the clinical population health processes, or the technology to truly support provider collaborations. The result is a large gap in data and/or actionable insights provided by payers to their provider partners who are managing patient care.
The typical resources provided by payers are very fragmented and difficult to integrate into provider operations:
In exclusive multi-product or multi-payer/multi-product VBC frameworks, this environment creates real challenges—even for the most sophisticated and highest performing providers. Trying to manage all the variations in VBC design and the gaps in completeness, timeliness, and accuracy of data and analytics puts real pressure on busy care delivery organizations.
Providers who are in VBC partnerships with multiple payers have the additional burden of working with different technology solutions and processes since no two payers are ever alike, which limits the ability to simplify and scale processes.
Lucerna Health believes there is a better way to integrate and empower busy providers to succeed in VBC models through an end-to-end VBC operating system: