Feature August 11, 2021 John Bernot, MD

How to select the value-based care model that’s right for your practice

Navigating alternative payment models: 3 questions to help your orthopedic practice select the optimal value-based care payment program

Value-based care (VBC) has come a long way since its inception. 

Over time, what started as voluntary initiatives to collect and report quality measures led to programs that paid providers for quality reporting. Within the past ten years, this has quickly evolved from pay-for-reporting to pay-for-performance, which has subsequently birthed an explosion of alternative payment models and incentive programs.

The financial health of your practice depends on your ability to navigate this new payment landscape. However, with so many programs cropping up, it can be challenging to make sense of them all.

Read on to learn three questions to ask to determine if a payment program is optimal for your practice and how digital health tools can help you meet your value-based care program goals.

Navigating the alternative payment model landscape 

There isn’t much coursework on alternative payment models and reimbursement strategies in medical school. Surgeons and practice staff have had to learn as new programs become available. 

Here’s a sampling of the type of models your practice may be considering participating in: 

  • Accountable care organizations
  • Bundled payment programs
  • Commercial payer programs
  • Shared savings programs

As your practice dives into the details, it’s critical to differentiate between mandatory and optional programs. CJR is a mandatory program, whereas EQIP and BPCI-Advanced are optional programs in which not all providers are required to participate. 

Now is the time to experiment with alternative payment models and find the strategy that’s right for your practice before they become mandatory. 

3 questions to determine if a payment program is right for your practice

When evaluating payment programs, here are three essential questions to ask: 

  1. Is there alignment between the payment program and your patient population? Providing the best possible care for your patients is a priority.  As we know, what’s best for one patient might be different than what’s best for another. Ultimately, you want to participate in the payment programs that will have the greatest positive impact on your patient population. Start by understanding what population the payment program will serve and see if that population aligns with your practice population. 
  1. What resources are required to participate? Some shared programs provide training, tools, and registries that make it easy for practices to participate, while others require that you have the infrastructure and resources in-house to comply. Regardless of the resources provided by the program, the greatest burden falls on your staff, who have to change workflows and documentation practices and learn the ins and outs of continually evolving payment programs. 
  1. What’s your risk threshold? It’s important to understand what level of risk you are comfortable taking on. Practices with 20+ partners might be willing to take on more risk as compared to a smaller practice owned and operated by a two-person team. Ask yourself: Do the financial rewards of this program outweigh the risk and cost of participation?  

How digital health tools can help your value-based care initiatives

The transition to pay-for-performance further increases the need to improve patient outcomes with the added burden of proving it.

A perioperative digital health solution can help your practice meet the demands of new payment models by enabling patients to: 

Learn how Ayva can help your practice meet its value-based care goals and maximize reimbursements in an evolving payment landscape.

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