Anne Marie Rainey, RN, MSN, CHC
As the healthcare delivery and payment system continues the shift from volume-based to value-based care, providers, support staff, and administrators have a responsibility to invest time and resources into practice transformation activities. Advanced practice providers (APPs) are in a unique position to facilitate the shift from volume to value through internal resources and interdepartmental collaboration, leveraging community partnerships and transformation in personal practice style.
What Is Value-based Care?
Value-based care (VBC) refers to a healthcare delivery model in which payment is based on patient outcomes or measures.1 While VBC is not a necessarily new concept, its application in oncology has gained momentum over the last several years with the implementation of the Oncology Care Model. VBC initiatives in oncology may include alternative payment model (APM) implementation, clinical care pathways for both treatment and symptom/toxicity management, as well as other clinical and administrative initiatives to impact care outcomes and costs of care. The goal of VBC in oncology can be most simply stated as providing high-quality care at a lower cost.
Lewin’s Theory of Planned Change outlines the stages of change as unfreezing, moving, and refreezing. In the unfreezing stage, one gains an understanding of the need for change. In the moving stage, there are processes put in place to initiate needed change. Lastly, in the refreezing stage, a “new status quo” is established. 2 APPs can use the stages of this change theory to make the shift from volume to value.
Internal Resources and Interdepartmental Collaboration
In most practice settings participating in VBC initiatives, there is a key leader or team of stakeholders responsible for implementation of these initiatives. If not already in place, APPSs need to engage with this internal resource to understand current VBC strategies and needs. Why is this important? Current initiatives, measures, and metrics will be impacted through patient care and documentation provided by APPs. This represents the unfreezing phase in the shift from volume to value and helps create an understanding of the essential components of VBC models in practice.
To be successful in the goal of enhancing patient quality while reducing cost, the APP needs a clear understanding of the organization’s current goals, strategies, and internal resources. Base knowledge paired with action items presents various opportunities for an APP to utilize internal resources in place. From a documentation and treatment standpoint, this could be demonstrated by maximizing technology through electronic health records workflow, clinical decision support tools, and other means to align the APP’s daily actions with organizational goals. In patient care opportunities, collaboration with internal departments, such as nursing, social services, and the financial services team, creates a holistic approach to better anticipate and address patient needs in a VBC model. In this area, both concepts of unfreezing and moving can be leveraged. Newly explored concepts paired with a willingness to embrace a new process or approach can lead to innovation and transformation.
Leveraging Community Partnerships
In thinking through areas that require the concepts of unfreezing and moving, the APP can play an important role in creating and maintaining community partnerships in VBC models. Many patients will have needs that are unable to be addressed under the umbrella of oncology; prudent use of outside, community services is paramount to VBC model success. It is essential to view this coordination of care as a key driver in the success of both the patient’s outcomes and success in a VBC model. In making referrals to outside services or facilitating care coordination needs, it is important to consider the quality of care and value that other organizations or practitioners provide the patient and if this aligns with the organization’s goals and strategies.
Transformation in Personal Practice Style
The shift from volume-based care to value-based care requires a commitment from APPs to establish a new status quo, or refreezing, when approaching and delivering patient care. Self-assessment and regular reassessment are instrumental to facilitating transformation in day-to-day practice. Through leveraging knowledge, internal resources, and collaboration; strengthening community partnerships, and committing to a transformation in practice style, APPs can excel at caring for their patients in a VBC model. Approaching the shift from volume to value with the goal of personal transformation poises the APP to be the change agent not only for the patient but for collaborating providers and support staff.
Anne Marie Rainey, RN, MSN, CHC, is the director of quality and value-based care at Clearview Cancer Institute in Huntsville, Ala., where she manages internal quality programs, government programs, and value-based care programs.
References
- What is value-based healthcare? The New England Journal of Medicine Catalyst. (2017). https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558
- Barrow, J.M., Annamaraju, P., Toney-Butler, T.J. (2021). Change Management. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459380/
RN, MSN, CHC
