In Brief: In part three of our ongoing series on value-based care (VBC), we explore how physician enterprises can operationalize their VBC plans through an effective staffing infrastructure.
At its heart, healthcare is about people taking care of people, with providers and support staff being the lifeblood of any medical practice. Healthcare workers are called to their profession by a desire to serve others.
VBC provides a pathway to that vision by aligning payments with how successfully those people take care of other people. By reconfiguring the support staff infrastructure within a provider organization and thinking creatively about the accountable physician enterprise’s patient population and its needs, a team-based care model emerges—one that works collaboratively with patients and caregivers to achieve high-quality outcomes. Designing and operationalizing that model is key to organizational success in the transition to value.
Aligning Your VBC Goals with Your Patients and Practice
The first principle of the transition to VBC is to understand your patient panel and its demographics, along with your practice’s value-based goals, and then align support staff accordingly.
Staffing dollars are limited, and each new role must be carefully assessed to ensure it is right for the organization. A few key questions will inform the planning for a value-based staffing infrastructure:
1. How would you describe your current and planned future patient population, and does this population have any predominant characteristics you plan to address through VBC?
- A primarily senior population with accompanying social and/or medical concerns
- A population that is medically complex with risk for high-cost medical events like admissions, readmissions, and/or ED utilization
- A population with high rates of substance use and behavioral health concerns
- Patients with high rates of social needs and/or limited finances
- A mix of patients and needs, where the practice is focused on providing different types of care to a broad population
2. What is your current payer landscape and strategy, and how is it expected to change over the next three to five years? What do you expect to experience or prioritize in your upcoming payer contracts?
- A transition to financial and population health, with greater emphasis on utilization (e.g., PCP visits per 1,000) or health maintenance activities (e.g., cancer screening rates)
- An increasing number of patients enrolled in Medicare Advantage, managed Medicaid, and value-focused commercial plans
- Adherence to evidence-based care for key clinical conditions (e.g., diabetes, heart failure)
- Accountability for outcomes and care outside your practice (e.g., all-cause readmissions rates, SNF to admissions)
3. Where are the areas of opportunity within your clinical operations that will enable you to achieve VBC delivery?
- Patient access, including an adequate number of urgent, same-day, or next-day visits
- Patient adherence to clinical screening recommendations and follow-through on referrals, which can include connecting patients to social work and behavioral health services
- Overall operational throughput, wait times, and care navigation capabilities
Building the Right Staffing Infrastructure
To support the VBC transformation, new skill sets, and support staff members will be needed. The titles will vary from organization to organization, but generally these functions include:
- Complex Care Management: Depending on the patient population and VBC focus, complex care managers will generally be either social workers or nurses. Their role is to help manage high-risk patients and, importantly, patients at risk of becoming complex in the outpatient environment, in order to minimize avoidable ED or inpatient stays.
- Panel Navigation: With a focus on screening rates and adherence to evidence-based protocols, managing the patient panel takes on greater importance. A panel navigator, panel manager, or outreach coordinator, who may be a trained layperson or a medical assistant if a clinical credential is preferred, conducts both inreach and outreach. Like outreach, inreach may be focused on particular campaigns (e.g., flu shots), general health maintenance (e.g., a patient who is due for a colonoscopy), or reaching a screening threshold for the clinic or physician (e.g., a physician needs two more mammograms for their population to meet their quality goal).
- Ambulatory Pharmacy: The clinical, ambulatory, or population health pharmacist participates in the care of complex and rising-risk patients. The pharmacist will play a key role and focus on medication management for their assigned population, including prescription adherence, medication reviews and patient education, identification of cost-effective alternatives, and management between visits. In a traditional model, a provider may consult with a pharmacist on occasion, while in VBC the pharmacist is fully integrated as a member of the care team.
- Behavioral Health and Social Work: This may be a licensed therapist, substance use counselor, social worker, or related role, depending on the social needs of the practice’s patients. In some organizations, there may be significant social and behavioral health needs, and the team may include more than one caregiver. Typically, these team members will be supported by psychiatrists or psychologists to whom more complex patients can be referred or from whom an electronic consult can be obtained.
Source: Medication Management | Improving Primary Care Team Guide
The final consideration related to staffing is how and where the support staff will do their work. While remote work and centralization are popular among staff and employers both, there must be a balance to ensure team dynamics are maintained. As the care team grows, cohesion and role clarity are essential to ensure each team member knows and fulfills their role and all tasks are completed. Using standardized workflows will allow all care team members to understand their role within the context of the clinic as a whole. Team-based care is a new concept for many practices and requires flexibility and understanding to implement.
Staff Redesign for VBC
A transformation to value enables providers to care for patients holistically, helping to address not just their medical conditions but their social and personal needs as well. This requires a strategic overhaul of existing staffing infrastructure—your organization will have new work to complete, requiring new skill sets. Conduct a detailed review of existing support staff and skills to identify competencies that can be developed from within and new roles that need to be created, such as care coordination, triaging, and value-based documentation skills. An effective staff infrastructure designed for VBC will position an organization to achieve success under value-based contract arrangements, whether those are shared savings, quality bonuses, or capitation arrangements.
What’s Next?
In the final post in our value-based care series, we will explore the importance of optimized IT, EHR, and analytical tools for value-based care.
Contact us for expert guidance in navigating your organization's value-based care staffing model.
Edited by: Matt Maslin
Published January 22, 2024
