Easing into value-based payment: A guide to getting started
You can get started in value-based care while operating in a fee-for-service (FFS) environment with a few practical, incremental steps.
Value-based payment models are reshaping care delivery and physician compensation.
Understanding value-based payment (VBP) models
What is value-based care?
Value-based care focuses on outcomes instead of volume. It encourages physicians to provide efficient, high-quality care that supports better patient health and helps lower overall costs. In this model, payment is tied to how well a physician manages the health of their patient population, not the number of services delivered.
How payment models impact patient outcomes
In value-based models, physicians work in teams, track population health and proactively manage chronic conditions. These efforts result in fewer unnecessary tests, better care coordination and improved patient engagement. The outcome is healthier patients, fewer hospitalizations and reduced costs.
Steps to transition to VBP
Key considerations for physicians
Transitioning to VBP doesn’t require an all-at-once overhaul. Many family physicians start by making targeted improvements within the FFS model.
You don’t have to do it alone. Practices that succeed often lean on team-based care, assign new roles to existing staff and use patient data more effectively. As you make changes, accurate diagnosis coding becomes especially important. It ensures the complexity of your patient population is reflected in performance metrics and reimbursement.
The following are three key steps to help you get started.
Step 1: Optimize FFS
Take advantage of FFS billing codes that reward preventive and coordination services. For example, the annual wellness visit (AWV) is an ideal way to generate revenue and build skills that will help you succeed in VBP.
Make the most of FFS
Pick a service area to focus on. The Medicare AWV is an excellent springboard, and the AAFP offers tools to help you get started.
Review and understand the components of the AWV using the Medicare Learning Network’s wellness visit education tool.
Create a list of patients with multiple chronic conditions or who haven’t been seen recently. Check whether a patient is eligible for an AWV (i.e., they haven’t already received one). Learn more about checking eligibility by reviewing a CMS fact sheet on Medicare eligibility.
Call patients on this list with Medicare to schedule an AWV. As patients schedule their AWV, educate them on the visit’s benefits and purpose.
Member tip: Have pre-appointment conversations
To make AWVs more effective, one practice has navigators and nurses contact patients at home ahead of their appointments. These conversations—often 20 to 30 minutes long—allow patients to review medications, involve family members and complete required elements in a familiar setting. When the patient arrives, the physician focuses on follow up and planning. This approach increases the number of wellness visits completed each year by shifting much of the work to a time and place that’s more comfortable for the patient and more efficient for the care team.
Step 2: Empower your team
Value-based care models give your care team a greater role in managing patient needs. As previously noted, the AWV provides a good entry point for using team-based workflows and building effective care coordination networks that support proactive outreach, followup and shared responsibility across your practice.
How to advance a team with the AWV
Have a team member send the patient a health risk assessment a day or two before their visit. The patient can load the information into your patient portal or bring it to their appointment and staff can enter it into their record as they room the patient.
Train staff to collect and enter other components of the AWV, such as current vitals, medical and family history, records of previous screenings (e.g., when the patient had their last colorectal cancer screening), and current health care professionals and suppliers
If your practice already uses team-based care, consider moving toward advanced team-based care.
Member tip: Shift team roles
One practice successfully transitioned a longtime medical assistant into a chronic care manager, a role often assumed to require an RN, LPN or social worker. Her strong patient relationships and communication skills made the shift seamless. This change was part of a larger effort to shift from reactive care to proactive planning. The team created new workflows, including outreach to patients recently discharged from the emergency room to ensure they filled prescriptions and avoided readmission. These changes helped establish a culture focused on prevention and planning, starting with an annual visit for every patient.
Step 3: Improve diagnosis coding to reflect patient acuity
Documenting the complexity of your patient population allows for more accurate quality and cost assessments. This helps ensure fair payment for the work you’re already doing—and when combined with data for quality improvement, it can also help track population health trends, benchmark progress and uncover opportunities for better care.
How to improve diagnosis coding
Educate clinical and front office staff on the importance of accurate diagnosis coding, so everyone understands what the team is trying to accomplish and the role they play.
Use a team-based approach. Only physicians and other qualified clinicians can make a diagnosis, but everyone on the care team can help ensure each diagnosis is documented appropriately.
Use the AWV to document all relevant diagnoses at the highest level of specificity, remembering risk scores reset annually.
Member tip: Build a consistent, proactive system
One clinic uses a system called “every patient, every time” to improve risk adjustment and preventive care. No matter why a patient comes in—whether for an annual wellness visit, allergy shot or a quick sick visit—the care team checks for overdue screenings or diagnoses that require attention. Even if issues can’t be addressed during the same visit, they’re flagged in the record so they can be followed up at the next appointment. This consistent process helps ensure high-quality, proactive care.