For years, medical professionals have discussed the need to transform the healthcare system, while also keeping it available to all people. There are many different ways of doing this including government programs, fee-for-service, Medicare programs, waivers, etc.
Value-based care is an approach to medicine using population health tools, contracts, and services to change the way we provide care. Of course, value is in the eye of the beholder. What makes one program more valuable than another?
Years ago I had the privilege of caring for patients on hospice. I learned the value of life. I also learned what true collaboration among a team of interdisciplinary professionals could look like. We had social workers, volunteer coordinators, chaplains, licensed nurses, patient caregivers, and administrative teams, as well as physicians all working together.
When I moved into primary care, our goal was to be able to offer our patients the same type of service. The biggest struggle is trying to find a way to pay for all these resources, as many of them do not have billable codes in the world of fee-for-service to compensate for the practice having such amazing team members. As we begin to shift away from fee-for-service to a fee for value world also known as value- based care, there are new opportunities for reimbursement that include the above. I like to look at it as navigating the healthcare system.
The world of value-based care focuses on the patient experience as well as the provider experience. Our goal is to offer new supports to the provider they have never experienced, eliminating the investigational care that comes from patients seeing providers outside their clinics. We pull all the information into their day-to-day workflow.
These past two years dealing with Covid has stretched people and resources unlike any other in recent history. My family dealt with Covid in August of last year and I remember dropping my husband off at the hospital saying goodbye not sure if I would ever see him again. The post-traumatic stress of that occurrence is one I don’t even think I have unpacked. Covid tore through my entire family. I’m in the healthcare industry and it still was difficult to maneuver. That is why I’m so passionate about helping others who are less experienced in the healthcare world navigate our system. My main goal is to help people by being with them every step of the way.
I remember a few years ago one of the providers was very frustrated because insurance would pay for his patient to have open heart surgery but wouldn’t pay for a dietitian to help him so that he never needed open heart surgery. That resonated with me for a long time. Dietitians and nutritionists could be so impactful in a disease process such as diabetes and congestive heart failure.
While we are in a unique change to healthcare, we are not perfect and there are still things we have to conquer. But I am proud of where we are going and getting away for paying providers to do things and actually finding a reimbursement model that pays to prevent illness. Let’s disrupt the current state of medicine with a patient and provider focused approach.
Katila Farley, RN, CMOM is the Senior Director of Value Based Care Alabama at Complete Health.
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