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Education/Quality Improvement

(19.11) The Path To Value Based Care : Benefits For Patients, Endocrinologists, And The Healthcare System (Includes Case Studies)

Saturday, May 11, 2024
10:30 AM – 10:45 AM CDT
Location: ePoster Showcase, Empire Ballroom Foyer, Level 2
Introduction : In the healthcare landscape, quality standards and reimbursement models are shifting from Fee for Service (FFS) to value-based care (VBC). This change has profound opportunities, especially in diabetes management, to improve patient care while improving practice revenue. This marks profound transformation, particularly in the future of diabetes management. VBC prioritizes patient outcomes and cost-effectiveness, departing from a focus on FFS which is aligned primarily with volume of patient visits. Through a three-phased approach designed to empower endocrinologists to thrive in the VBC model, payers, patients, and providers all stand to reap substantial benefits. The first phase concentrates on expanding within the FFS framework, ensuring a broader reach for endocrinologist-led treatments among patients. The subsequent phase involves optimizing practice operations and implementing tailored care plans. The third phase facilitates the transition of practices towards VBC contracts, offering support for contract design and providing comprehensive education.

Case(s) Description :

There is a shortage of endocrinologists available to support and treat the increasing population of patients with diabetes (PWDs). Consequently, many PWDs are not receiving the quality of care necessary to improve their health outcomes. This shortfall also leads to increased healthcare costs due to complications and hospital admissions.  In phase one, by outsourcing aspects of Diabetes Care Management, Chronic Care Management, and Remote Patient Monitoring to telehealth providers not directly employed by the endocrinology practice, fee-for-service (FFS) care can be expanded. This expansion aims to enhance patient outcomes and boost provider satisfaction. In phase two, implementing an Endocrinology-focused Electronic Medical Record (EMR), negotiating payer contracts, and streamlining administrative components further expands on the benefits of phase one. Phase three involves the design of VNC contracts and negotiations between the payer and the At-Risk Provider. An external company, sharing risk with the provider, provides support. Under VBC contracts, providers are incentivized to achieve improved health outcomes in patients by allowing providers to share in the cost savings when better outcomes are achieved with a lower financial burden on CMS (Centers for Medicare & Medicaid Services).

Discussion :

Analysis of Medicare FFS Part A & B claims data from 2021-2023 reveals VBC and tele-health opportunities for Endocrinology practices. Nearly a million Medicare beneficiaries with diabetes served by Endocrinologists utilized $19 billion in healthcare services, while endocrinologists earned  approximately 2.5% of these fees. When people with diabetes are cared for by an Endocrinologist they have fewer complications and spend $260 PMPM, or $3,100 per year, less in healthcare resources. Telehealth and Remote Monitoring are underutilized by Endocrinologists despite proven benefits. The three-phase approach aims to enhance patient outcomes, physician satisfaction, and alleviate the healthcare system's financial and volume-based burdens.