What does value based care mean for pediatric practitioners?
Value based care empowers pediatric practitioners to optimize in-person sessions with inter-session technology-enabled support. Value based payments incentivize practitioners to focus on measured outcomes while utilizing family-centered budget.
What are value based payments?
Value based care is part of healthcare quality reform aimed at 3 things: better care for individuals, better health for populations, at lower cost (source: cms.gov.). Value based payments can take different shapes and forms such as: bundled payments for episode of care, shared savings and risk, rewards and penalties, capitated payment, population payment and more. Regardless of how these will be implemented in each program (Medicaid, CHIP, insurance…) there is one common base – payment will be made for value generated rather than service rendered.
This means that instead of paying per session, payment will be made per client, with some mechanism for incentivizing cost reduction. It doesn’t really matter what specific mechanism will be chosen for pediatric therapy, nor whether it will be governmental or market led. The bottom line will remain the same – practitioners have financial incentivizes to achieve the best outcomes for their clients. Practitioners will get paid based on these measured outcomes regardless of the number of in-person sessions they do.
The challenge of value based payments
The good news is that this transition is most likely to encompass 4 main steps: measure results, document care paths, create interdisciplinary teams, engage in human-centered design (source: Journal of Health Management, Volume 17 – Issue 1, 2017). Most pediatric therapy disciplines – occupational therapy, speech and language therapy, behavioral therapy, emotional therapy pediatric physical therapy – are well underway to incorporate these elements. Measured outcomes, evidence-based care path, interdisciplinary staff and family-centered practice are not new concepts to pediatric practitioners.
The challenge lies in the simple fact that unlike other health related areas where one might reduce costs by reducing unnecessary procedures, in therapy the main cost driver is therapist time – which is highly inelastic. Assuming no new Silicon Valley startup will be able to add a 25th hour to a day… there are only so many families and kiddos a practitioner can see in a day, week and month, and still be effective… So other than doing a better job at measuring, documenting, collaborating and adopting a family-centered approach – what can you do to prepare for value-based payments?
The opportunity of value-based payments
Value based payment can actually be a great opportunity. Let’s ask ourselves: can we provide the same (or better) service at a lower cost knowing that we get paid for value generated and not for face-time? In other words, let’s take for example a therapist that is treating a family in weekly sessions (at home or in clinic) over an evaluation period of 6 months, after which the family may or may not be eligible for another 6 months’ period. And let’s assume this therapist has several such families, some will be able to extend therapy and some won’t. What if we were to take that total cost of therapy over what might average, say 9 months, and ask whether it could be used differently to achieve similar or better results for all families?
Another way to think about it is to assume that therapy is paid for by the family out of pocket, there is no reimbursement or coverage of any kind. And let’s assume that each year the family can afford a cost equivalent to 6 months of weekly sessions with a therapist. How would you best recommend the family to utilize this budget? Would you recommend they stick to weekly sessions for 6 months and then have a 6 months’ gap, or switch to bi-weekly frequency throughout the year? Perhaps have more frequent sessions at the start of therapy followed by some remote tech-assisted monitoring of inter-session work done by the family, and supplemented by in-person sessions when difficulties arise, leaving some budget left for purchase of special equipment and developmental toys that make the inter-session work more effective. Wouldn’t that be a better use of the family budget? Get them closer to what therapy is all about – an empowered family that can self-care?
The empowering effect of value based payments
To recap, we’ve seen that value based payments can be implemented in many ways, yet all have in common one thing – practitioners are going to get paid based on their clients’ measured outcomes rather than face-time sessions. While this is highly aligned with existing approaches such as family-centered practice, value based payments will add a financial incentive to push these even more. However, value based payments also hold a disruptive opportunity to provide better care at lower cost. With value based payments, practitioners will be empowered to optimize family budgets. Making room for innovative and personalized care paths. Each family will be given the customized mix of in-person sessions, inter-session remote support, assistive technology and developmental toys. Ensuring better outcomes based on family-centered budget utilization. Optimizing this mix is the truly empowering nature of value based payments, and their challenge…
Oren Steinberg is co-founder of SensoryTreat, providing a carryover empowerment platform for pediatric therapists and caregivers of children with Autism and other developmental disabilities.