Article Date: 5/1/2011

Are You Ready for Value-Driven Healthcare?

Are You Ready for Value-Driven Healthcare?

New laws will make outcomes public and pay you according to cost and quality. But don't panic, get prepared.

Special Section Sponsored By OD Lean

The “What does it mean to me?” reality of healthcare reform has begun to sink in … Perhaps you've already taken advantage of government incentives to implement electronic health records (EHRs). EHRs are a major transition, but an even greater challenge looms large. The shift to value-driven healthcare has concrete consequences for your practice. Don't wait: prepare now and be sure to get the right help.

What Is Value-Driven Healthcare?

Value-driven healthcare is a change in the way patients choose doctors and, more influentially, in the way insurers reimburse you.

“True healthcare reform began a decade ago, when we moved away from fee for service. Now the shift is on to a pay-for-performance system, under the even bigger umbrella known as value-driven healthcare,” explains Tommy Crooks III, OD, founder of Eye Care Associates, Inc., in Birmingham, Ala. “The underlying rationale is that fee for service is not sustainable, a fact that's easy to see when we extrapolate the rate of increase in healthcare costs just a decade into the future. The situation has to change. Enter value-driven healthcare. It's different from anything doctors have dealt with before.”

Insurers need to get more bang for the buck, so the “value” in “value-based” is a correlation between the quality of the outcomes you achieve and the prices you charge. Every doctor's clinical outcomes will be available to the public—first on a voluntary basis, and then on a mandatory basis. Not only will patients make choices based on outcomes, insurers will also base reimbursements on a doctor's value (combined outcomes and price). To succeed, you need to achieve better outcomes than your competitors for a lower price.

“Better outcomes mean better pay,” Dr. Crooks says. “We will all, by definition, see more patients for less reimbursement. We have to attempt to achieve the best outcomes at the lowest cost.”

You Can Do It

Even knowing that value-driven healthcare isn't far away, it's hard to visualize such a fundamental change in how you practice. Dr. Crooks has taken steps to prepare, helping to shape the ODLean program as a consultant, then putting 11 of his 20 practice locations through the ODLean process.

“Value-driven healthcare is where the ODLean program really shines. Doctors don't know how to see more patients for less reimbursement, but the ODLean program is specifically designed to find you more time,” Dr. Crooks explains. “It identifies systemic bottlenecks and time sinks, streamlines processes, improves flow, and helps practices make fundamental changes and implement new efficiencies—all with an eye toward where practices are going in the new value-driven world. And that's how we're able to see more patients in a day while maintaining the best outcomes.”

Dr. Crooks says the changes don't have to hurt. “People don't want to think about it now … it's a major change and none of us likes that. But we don't have to undergo a value-driven healthcare transformation independently. Help is available for the transition.”

Still No EHRs? Don't worry–just hurry.
Value-driven healthcare relies on EHRs—necessary for transparency, mobility and better outcomes at a lower cost—but many practitioners don't have an EHR system.
“EHRs are the first fundamental building block of the value-based healthcare system. Doctors who still don't have EHRs or practice management software need to take advantage of government incentives to implement them as soon as possible,” says Dr. Crooks. “Documents need to be accessible to patients, other providers, facilities, imaging centers and hospitals—every link in the chain. It's not easy, but ODLean can serve as a consultant or a coach to get this foundation in place for the future, but it needs to start happening now.”

This article is the second in a six-part series about ODLean, a new kind of consultation service offered through The Vision Care Institute. In the coming months, read about the innovative program and meet some of its nearly 100 clients.

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Contact Chuck Smith at (904) 443-1081 or for more information

Optometric Management, Issue: May 2011