Challenges to ACO_resized

Top 4 Challenges Faced by Providers Moving Toward Value-Based Care

Some of you might remember this viral YouTube video of a girl learning to dance over the course of a year. It inspired me and reminded me of challenges facing the healthcare providers in the transition from fee-for-service to value-based care. And how on earth could a cool dance video do that, you ask? Because it turned the seemingly impossible into something beautiful just like this transition will.

It also reminded me that sometimes learning new things is scary but passion and confidence will bridge the gaps and the results will be worth every effort. This is true of learning to dance or having a new way of thinking and behaving in healthcare.

During my research for the ACO Advisory Services, I’ve found 4 common concerns the healthcare organization executives have voiced in our conversations.  

1. Unknown Return on Investment

Providers understand valued-based care is the right direction, but the front-end investment can be so cost prohibitive that they question how they can be financially viable in the model.

“Even if I maximize the shared savings out of our CMS program, or our capitated program with this health plan and this SSP program with that one, etc. etc. it doesn’t add up to enough money to cover the cost of all these big expensive projects that people want to sell us or the tools that we have to have and we’re just trying to explore some more cost effective ways of getting where we need to be.”

2. Living in both Volume and Value Worlds

Even though the portion of Fee-For-Service (FFS) as a reimbursement will continue to shrink, it is not going away in the short-term. Providers will learn how to better manage risks but, at the same time, run both of the care models.

“I would say managing while we have a foot in each cam…is very challenging for us, both operationally and from a clinical practice standpoint, to create it. Ideally, we like to have a consistent operational and care model. It is very challenging to have that when only a portion of our patient population is at-risk and the majority of it is Fee-For-Service. So simultaneously managing those divergent incentives is difficult.”

3. The Need to Understand True Cost of Care

The true cost of patient care is very much needed yet a myth to many providers. Only when providers get a handle on understanding it, will they feel confident in taking on more risks.

“I know we don’t have this figured out but what is going to be very, very important is to be able to pull data around the cost of care and comparing the actual care path against an ideal care path so we can identify the variations by physician, by type of patient. I think that is what is going to be very important.”

4. Commercial Technology Lags Behind Provider Needs

ACO and pop health management markets are still like the wild, wild west. The number of solutions that claim to help providers can be overwhelming but are still not proven.

“I would say that there is no great solution out there…today that I think is the end all, be all. You may come across organizations that have some solutions, proprietary or off the shelf, products that are great. I have seen some slick products out there but I haven’t test-driven them.”

I believe that, like the girl learning to dance in this video, when we try, we can surprise ourselves. This transition might be something new to many organizations but, as this provider described her passion and responsibility, we can all adapt and become “pro’s” soon enough:

“I took this job because I really believe we can do better in healthcare, we can coordinate efforts and we can stop dropping balls and we can reduce waste and really get all these different specialists in a room that never have that opportunity to start talking about this stuff. This has been for me the most exciting part of the whole entire thing.”

Will consulting firms engaged by the providers help provide a pathway to resolve these top challenges? We look forward to sharing our results in our up-coming ACO Advisory report, coming October 30th.