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Healthcare CIOs straddle fee-for-service, value-based care

For health systems with one foot in a fee-for-service model and the other in value-based care, reimbursement for services can get tricky.

BOSTON -- While healthcare organizations shift their focus from quantity to quality of patient care, health systems can get stuck in both worlds.

The 11th annual mHealth & Telehealth World Summit this week kicked off with a strong focus on value-based care and the growing shift to quality care and better patient management. Attendees also learned how healthcare organizations can move away from long-standing fee-for-service models and find ways to generate revenue through quality care.

Conference speakers focused on using telehealth, remote patient monitoring and virtual care tools to enable better quality patient care. Yet focusing on population health and managing patients to enable better care can be a challenge for healthcare systems because some are stuck in each world, both with vastly different reimbursement models.

The state of value-based care
Value-based medical care has led to increased patient satisfaction and lower costs.

One foot in fee-for-service, the other in value-based care

In a fee-for-service model, healthcare organizations are reimbursed based on the number of services provided, such as lab tests, X-rays and procedures. In a value-based care environment, providers are reimbursed based on meeting quality measures and the general overall health of their patient population.

Being caught in the middle ground, partly in a fee-for-service model and partly in value-based care, is a significant challenge for healthcare systems, said Adam Landman, M.D., CIO of Brigham and Women's Hospital and a speaker at the mHealth & Telehealth conference.

For healthcare CIOs, one of the biggest hurdles in transitioning an organization to a value-based care model is shifting their mindset on investments.

In a fee-for-service world, Landman said, CIOs constantly think about driving more volume and thus driving more revenue. In a value-based care world, the focus shifts to taking care of an entire patient population and keeping them well. The incentives change under each model, as must the CIO's argument as to the value or ROI new technology will bring to the organization, Landman said. 

CIOs potentially have an opportunity to really think about a digital- strategy and really be a leader to help with the digitization of healthcare.
Adam Landman, M.D.CIO, Brigham and Women's Hospital

"Companies will approach a health system with sort of the value-based mindset in play and it is clear that a solution could really help a health system if they were totally on a value-based system and totally accountable for the patients," Landman said. "But if we're not totally in that model and we're still in a fee-for-service model, it can be hard to reconcile that."

Kim Swafford, group vice president of telehealth and technology strategy for Providence St. Joseph Health in Washington, spoke on a panel with Landman at the conference. She echoed his sentiments, saying while the goal is value-based care, there's still a long road ahead.

"We're still balancing both worlds, but I would say the organizational mindset is heading toward value-based care," she said.

Moving to a value-based care model

Swafford said when she looks at technologies that could help her organization transition to a value-based care model, she pays attention to seamless experiences and full integration with the EHR, and stays away from total reliance on vendors. Instead, she said it's important to work in collaborative partnerships.

The focus for healthcare CIOs is shifting, Landman said, and provides new opportunities to help lead technology efforts aside from basic infrastructure, email systems and EHRs that could enable a value-based care environment. 

"CIOs potentially have an opportunity to really think about a digital- strategy and really be a leader to help with the digitization of healthcare, to help roll out virtual care, to help roll out tools for patient experience," he said.

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