Value-Based Care

COURSE 3 of 7. This course is designed to introduce you to critical office-based processes that a value-based practice must manage in the drive towards improved patient outcomes. In Module 2, we’ll focus on office-based and clinical patient-based supporting functions. At every level in healthcare, guidelines, processes, and functions exist to improve outcomes, and following a consistent process will return the best effect. Refine your understanding of value and learn strategies to provide real assistance to patients to manage chronic diseases and navigate the complex healthcare system. Gain an overview of panel management, a systematic, proactive approach to identify and address unmet chronic and preventive care needs of patients that leads to better health outcomes. Learn how clinical patient-based questions related to immunizations, cancer screenings, or diabetes care can generate data to support a strategy of identifying non-utilization patterns. In the summative assignment, you will demonstrate your knowledge by explaining and synthesizing the importance of office-based processes and patient-based supporting functions to improve patient outcomes and experience as well as clinical quality. As you reflect on what you have learned in this course, you will also have an opportunity to consider the relationship between managing these processes and functions and the fundamental premise of value-based care.

COURSE 1 of 7. This course is designed to introduce you to the concept of value-based care (VBC). While the information you will explore is general, it will help you establish a solid foundation for continued learning and future thinking about the concept of VBC. Through a historical lens, you will explore the creation of Medicare and Medicaid and the evolution of commercial insurance, TRICARE, and the Veterans Health Administration. While history is an important filter for understanding healthcare in this country, you will learn how each of these mechanisms emerged, the populations served, and what changes occurred over time, with a focus on funding and expenditures. In addition, this course will help you establish a firm foundation for understanding the development and evolution of quality measures and outcomes in healthcare. By developing an understanding of what quality is and how it is measured, you can begin a knowledge-building exploration of the components of quality in healthcare. Why is this important? In value-based care models, providers must meet quality measures and improve the health outcomes of their patients. In the summative assignment, you will use a national system of quality measures to develop a plan that would positively impact value within your healthcare organization.

COURSE 2 of 7. This course is designed to introduce you to the concept of population health and related key terms. Refine your understanding of population health and what influences health care costs. Gain an overview of population health management, beginning with a high-level review of four critical areas: addressing behavioral and social determinants of health, the prevalence of chronic disease, attributes of an aging population, and key barriers of access to health care. Use the Population Health Pyramid to organize a care delivery system to meet the needs of population groups—all with an eye towards achieving better outcomes through the fundamental premise of value-based care. In the summative assignment, bring together the elements of a community health assessment and community health improvement plan into a logical and organized whole by selecting a particular community that is important to you, applying data, and determining relevant assets.

COURSE 4 of 7. This course is designed to help you build high-level knowledge of the current medical coding and payment mechanisms of most U.S. healthcare services, referred to as fee-for-service. You will explore why the fee-for-service model has contributed to higher costs in the U.S. healthcare system without clearly improving health outcomes. You will examine the importance of coding to reflect chronic conditions and other diagnoses accurately and how value-based care and payments utilize these measures and data. As you learn about a model to replace fee-for-service, you’ll encounter a range of payment options considered to be value-based that utilize a framework from the Health Care Payment Learning and Action Network (HCP-LAN). To build on those options, you will learn how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. In the summative assignment, you will demonstrate your knowledge by comparing fee-for-service and value-based contracts, using specific examples to explain and justify the importance of documentation and coding, and identifying ways that risk-adjustment and patient satisfaction are incorporated into value-based care contracts. CME Accreditation The American Academy of Family Physicians (AAFP) has approved this course for Continuing Medical Education Prescribed Credits. Visit the FAQs for important information regarding 1) Term of approval and 2) Accreditation and Credit Designation statements.

COURSE 5 of 7. This course is designed to introduce you to the changes an organization will need to make to succeed in value-based care and payment. In previous courses in this specialization, you were introduced to the Accountable Care Learning Collaborative (ACLC). One of the models you will explore is the ACLC’s Accountable Care Atlas model. This model, along with additional information from the Health Care Payment Learning and Action Network (HCP-LAN), will help you begin to understand the challenges and rewards of transitioning to value-based care. In Module 2, you will explore those concepts through the lenses of three types of healthcare organizations, tying those examples back to types of value-based contracts. You will also explore strategies to address some of the challenges in the journey to value-based care. In the summative assignment, you will demonstrate your knowledge by envisioning that you have been invited to speak as part of a roundtable discussion on the challenges of transitioning to value-based care and payment. You will develop an outline of talking points in which you will share why VBC is valuable, the challenges and strategies that might address them, and where you see opportunities for progress in the transition to value-based care.

COURSE 6 of 7. Fragmented healthcare has created the need for healthcare reform, changing how healthcare is delivered and managed by shifting the structure and culture of healthcare organizations across the U.S. In this course, you will explore ways that provider organizations can successfully move from volume to value through implementing Quality Improvement plans and Continuous Quality Improvement. Organizational improvement is a continuous process. To be successful means coming to grips with things you have to do, how they get done, and who needs to be involved. Paramount to the process is recognizing that every role—every team member—in the organization is important to a successful VBC strategy. You will also learn about adaptive leadership and how to advance vision and innovation through collaboration. Collaborative relationships between team members and leadership are critical to the transformation. You will explore strategies to gain buy-in, agreement, and understanding about the organization’s vision of value-based care and learn to engage team members in developing solutions to challenges. In the summative assignment, you will identify a measurable value-based care goal that would benefit from process improvement, describe how that goal will be communicated with the care team, and explain your role in leading the targeted improvements.