As value-based reimbursement becomes more prevalent, the right clinical strategy could be the difference between survival and success for many hospitals. Under ACOs and similar population-based payment models, keeping patients out of the hospital through better management of chronic illness and development of alternative care settings is increasingly important. But this approach only solves a portion of the problem because many health system leaders underappreciate the fact that 50% of Medicare spending occurs from the point of hospitalization through 90 days post-discharge. Coupled with CMS’ recently-announced move to mandatory bundled payments in 2023, managing spend across the acute care episode may be even more important in transitioning successfully from volume to value.
Building Tomorrow’s Care Model for Hospital Medicine
Overutilization and excess costs are terms that resonate with large employers and health plans, but often less with clinicians – whose hearts and minds focus on quality of care. As a former emergency room physician, and now the CEO and founder of the one of the country's largest physician groups with programs in over 350 hospitals, I've had my foot in both doors. Regardless of business or clinical views, it's always first and foremost about the patient. At Sound Physicians, we bring value-based care concepts to life in patient-centric terms while tracking performance through data and analytics. We track and share scientific evidence on achieving better clinical outcomes and demonstrate ways to improve the patient experience. When our hospitalists engage patients and their families in advance care planning conversations, they understand how aligning care with the patient and family's wishes leads to an improved patient experience, a reduction of unnecessary care, and ultimately better outcomes.
Unlike reactive utilization management tools that scrutinize clinical appropriateness solely based on algorithms, successful value-based care strategies use real-time technologies that enable clinical workflows and point-of-care decision making. The right tools empower our hospitalists to build proactive care plans upon admission, and we've developed a proprietary application, SoundConnect™, to do just this. Paired with our analytics platform, SoundMetrix™, which provides real-time, risk-adjusted performance feedback, we've purposely created systems to enable our value-based care workflows. Educating our teams on these tools, embedding it into their daily practice, and pairing it with their medical expertise leads us to the best solutions possible for the patient and our hospital partners.
Sound Physicians' value-based strategy is documented and well proven over more than six years, starting with our initial entry into CMS' Bundled Payment for Care Improvement initiative. We made the strategic decision to bear the risk of entering the program at its inception because we knew the shift from volume to value would take significant time and resources. While the first couple of years in the program proved challenging, we quickly outpaced the national trend in savings per episode.
Our national performance metrics in the program to date include:
- 15% reduction in 30-day readmission rate
- 26% reduction in utilization of SNF
- 6% reduction in SNF LOS
- 60% reduction in use of LTACH
- 12x increase in advance care planning use rates
- $1,000 savings per episode
- Episode costs decreased 50% faster than national BPCI trends
The advice I would offer to hospital executives looking to develop an effective approach to value-based care is to ensure physicians are the cornerstone of your strategy. This comes through the acknowledgement of both hearts and minds. You can win the hearts of physicians through the evidence of value-based care improving patient outcomes and utilize the minds of your team to create new processes and care models. When you obtain the buy-in of physicians to deliver value-based interventions, patient outcomes will continue to improve.
Dr. Robert Bessler founded Sound Physicians in 2001. As Sound’s chief executive officer, he ensures the organization seamlessly partners with hospitals, community providers, and payers to drive meaningful performance improvements while maintaining quality of care and patient satisfaction throughout the 90-day acute care episode.
Sound Physicians is a leading healthcare organization with a reputation of improving quality, satisfaction, and financial performance for partners nationwide. Sound combines a high-performance model with engaged clinicians to drive reproducible results across the acute episode of care through emergency medicine, hospital medicine, critical care, anesthesia, telemedicine, value-based care, and physician advisory services.