Value-based care. Everybody's talking about it but where do you find it?
A new report from PricewaterhouseCoopers' Health Research Institute (HRI) offers advice to organizations looking to pivot towards value-based care, serve consumers' need and save a couple of pennies for their piggy banks.
The idea largely revolves around reorganizing and extending primary care teams to be designed around consumer needs and preferences. The HRI team identified seven different primary care markets/patient types including:
- Frail elderly - Those over 75 years old facing health issues related to falls or dementia and suffering generally poor health;
- Complex chronic - Those with one or more chronic diseases affecting multiple body systems and often requiring complicated disease management;
- Chronic disease - Those with problems affecting a single body system (hypertension, for example) and require uncomplicated disease management;
- Mental health - Those with mental health issues as their primary health issue;
- Healthy families - Households with healthy dependent children under the age of 18;
- Healthy adult enthusiasts - Those who value a regular physical, wellness/coaching services, and receive recommended screenings; and
- Healthy adult skeptics - Those who generally avoid interacting with the health system and are less likely to have health insurance than other consumer groups.
"It's not one size fits all and healthcare providers need to be aware of that," Dr. Harlan Stock, health advisory manager at PwC told Healthcare Dive. "All of these different types of consumers are utilizing primary care but they are all doing it differently. Based on that, we can then reformulate how primary care is delivered."
While change is always hard, consider this: HRI found a primary care team designed around the needs of the complex chronic cohort could result in $1.2 million in savings based on a population of 10,000 patients. It should be noted the report was based on a survey of 1,500 U.S. providers in 2015 and 1,750 American consumers this summer.
HRI's model breaks out a primary care team by:
- Core care team which can include a PCP, geriatrician, nurse practitioner or physician assistant;
- Extended care team which can include a clinical pharmacist or nutritionist/dietitian; and
- Community connector team which can include a social worker or care navigator/coordinator.
"By reconfiguring the primary care team and extending the team out into the community, you're able to treat patients outside the walls of the traditional facility, the hospital," Stock said. "I think this model allows care providers the ability to differentiate themselves in the marketplace by offering extended care team members and community team members."
He noted not all patients seek and receive care in the same touchpoints of the care continuum. A patient population that skews toward complex chronics disease are going to be more likely to utilize primary care physicians over a population with a larger degree of individuals with mental health issues. The research found certain care team members such as nutritionists and mental health professionals are often under-utilized and more could be employed to deliver primary care. Providers that utilize these individuals could be better positioned to deliver care more ably and improve outcomes, Stock said.
"Different consumer markets will require different team rosters based on their whole health needs," the report stated. "Consumers’ interactions with the teams will be distributed more broadly for sicker populations and less broadly for healthier populations."
HRI purports such restructuring can help reduce stress among the care team by reducing administrative burden from care team members in addition to meeting patients in settings for their care needs. Capping the report off, HRI offers these tips for restructuring:
- Understand its consumers;
- Understand the impact and consequence of restructuring;
- Market dynamics should be a part of hte calculation; and
- Use data and analytics to design, deploy and deliver.