More providers are shifting from the traditional fee-for-service model. Michael Palantoni of athenahealth talks about the opportunities and obstacles.
Michael Palantoni says he is seeing growing support for shifting to value-based care, including discussions and cooperation that would have been unthinkable a few years ago.
Palantoni is the vice president for platform and data services at athenahealth, the electronic health record company, which is working with payers and providers on addressing gaps in care in the shift to value-based care.
“I think that's one of the most fundamental shifts in most value-based care models is that the traditional roles of the payer and the provider break down,” Palantoni says.
“You're seeing collaboration, not just at the business and incentive view of healthcare, but at the actual day-to-day care delivery workflow. We're getting providers and payers in rooms together saying, ‘What's the best way to do this process?’ And that's a big shift,” he adds.
Such conversations aren’t common in a traditional fee-for-service model, where providers are paid for each treatment or procedure, he says. But in value-based care, where providers are paid based on the quality of care, payers and providers are having more “bi-directional” conversations about sharing data and finding ways to cut costs and improve care, Palantoni says.
“You see the rate of collaboration really increasing in a very, I think, new and different way,” he says.
In a recent interview with Chief Healthcare Executive®, Palantoni discussed value-based care, athenahealth’s work with payers and providers on that transition, and what hospitals and providers can do to reduce gaps in care for patients.
While more providers are moving into value-based care, at least in some areas, the transition comes with some difficulties, Palantoni says.
“The evolution of VBC (value-based care) has not been terribly well supported by what we call the healthcare ecosystem,” he says. “Providers have been building their own applications and services and using the analytics apps, and you have the payers or the risk owner on the other side, building the equivalent apparatuses and keeping score. And so you've got this kind of rise in administrative cost.”
Palantoni says athenahealth is working with payers and providers to improve the exchange of information within the workflow, and identify gaps that could be interfering with patients getting the care they need. Hopefully, he says, that can drive down friction and costs in the system.
In working with payers and providers, athenahealth has found some surprising gaps in the area of preventive care, Palantoni says.
“That's so important to managing quality and risk for patients and yet, a lot of the time it's a tricky thing to actually get it right,” he says.
Since patients don’t always remember their last screenings or immunizations, it’s critical to have that information available for providers. It’s also valuable to have that data to see if there are factors making it harder for patients to keep up with screenings and appointments. For example, a patient may be missing appointments because of transportation issues, and with that knowledge, providers can intervene.
From Palantoni’s perspective, many providers support the concept of value-based care, but for some, the questions come with actually administering it in practice. He says athenahealth is working with providers so there’s minimal change required and they have the data they need in existing workflows.
The shift to value-based care is happening, Palantoni says. The Centers for Medicare & Medicaid Services has said it wants all of those enrolled in traditional Medicare in an accountable relationship with providers by 2030.
Now, athenahealth is getting more questions from clients about how to succeed with value-based care, and what tools are needed.
As health systems and providers are shifting to value-based care, Palantoni says they need to think about making investments in technologies with the workflows of their organizations in mind.
“You can have all the insight and intelligence you want, but if it's not part of the provider's day-to-day (workflow), it's not going to be used and you're still going to have subpar outcomes,” Palantoni says.
Looking at the long-term future, organizations should think about the adaptability of their systems, he says. Health systems should also work to determine if care teams are working with community partners to improve care in underserved populations. He also talked about prioritizing staff members for their ability to lead and communicate, in addition to caring for patients.
Health systems that have been slow to move to value-based care are often struggling with confidence and moving forward in a new environment.
“You can do value-based care if you've got a huge apparatus, and a lot of sophistication, but not everybody has that or could afford that, or even if successful, support it from a sustainability perspective,” Palantoni says.
“And so I think that the whole art of this is, how do we make these mechanisms more cost-efficient? You know, get the outcomes desired from value-based care and give the provider-organizations participating higher confidence in their ability to perform and succeed. So those are the big challenges we see.”