As the healthcare payment shift from fee-for-service (FFS) to value-based reimbursement takes longer than expected, health systems must balance existing volume-based models with a growing emphasis on value. Organizations are in different phases of the journey from volume to value, and policies continue to evolve. In response, the industry’s best stance is to sustain FFS revenue while following guidelines and strategies to be increasingly ready for value. Organizations can use four methods to remain agile as they navigate the limbo between volume and value: Understand the first ten years of value-based care and prepare for what’s next. Identify essential strategies for shifting from volume to value. Leverage the Medicare Shared Savings Program. Use population health management as a path to value.

1. Shifting to Value-Based Care:
Four Strategies Emphasize Agility
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Shifting to Value-Based Care
One of the common themes around
value-based care (VBC) is that the shift
from volume, or fee for service (FFS), to
value is taking longer than the healthcare
industry expected.
The delay has complicated the transition
processes, as organizations know they
must be ready for VBC but still rely on
revenue from FFS reimbursement.

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Shifting to Value-Based Care
COVID-19 will likely impact the move to VBC
one way or another, but expert speculation
remains divided on whether the pandemic
will accelerate or slow the transition.
With so many unknowns, organizations
must continue to support volume-based
reimbursement and remain agile and
ready to progress towards more value
when the time comes.
Health systems can navigate the
reimbursement limbo by assembling
strategies and guidelines to sustain
volume while preparing for value.

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
The following four approaches can help health systems balance volume with value:
Understand the First Ten Years of Value-Based
Care and Prepare for What’s Next
Identify Essential Strategies for Shifting from
Volume to Value
Leverage the Medicare Shared Savings Program
Use Population Health Management as a Path
to Value

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
Understand the First Ten Years of Value-Based Care and Prepare for What’s Next
The year 2020 marked a decade since the
passage of the Affordable Care Act in 2010
and healthcare’s first transitional steps from
volume to value.
As the industry enters into another decade of
value in 2021, health systems must consider
the impacts of these programs so far and
make sure they have the processes and tools
in place to succeed in an increasingly value-
driven industry.

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
Understand the First Ten Years of Value-Based Care and Prepare for What’s Next
The 10-year VBC progress report is mixed, as
CMS and healthcare organizations are still
evolving and adapting policies and strategies
to optimize outcomes and performance.
For example, while CMS’s emphasis on
quality and cost is driving an upward trend
for patients and providers with substantial
improvement in readmissions, organizations
still need to simplify and consolidate value-
based programs for more widespread
positive impact.

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
Identify Essential Strategies for Shifting from Volume to Value
The healthcare industry is suspended between
value- and volume-based payment models, as
unaffordability pushes the shift to value, but the
current environment still supports volume.
Health systems must understand the factors
driving and sustaining both payment models
and strategies for balance as value replaces
volume to survive economically.

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
Identify Essential Strategies for Shifting from Volume to Value
Ten strategies can help health systems balance VBC with FFS:
1. Maintain member perspective.
2. Make cautious investments in hard delivery assets.
3. Accelerate investment in digital infrastructure.
4. Introduce innovative digital engagement solutions.
5. Make pricing concessions.
6. Align incentives.
7. Manage networks.
8. Build payer-provider trust and collaboration.
9. Align clinicians and administrative team members.
10.Encourage physician leadership and accountability.

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
Leverage the Medicare Shared Savings Program
Providing care to Medicare patients has historically
yielded slim margins for health systems.
However, value-based programs, such as the
Medicare Shared Savings Program (MSSP),
are now making Medicare patients a potentially
lucrative population for organizations while also
helping providers deliver the highest level of
care to patients and communities.

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
Leverage the Medicare Shared Savings Program
Under MSSP, health systems can optimize
their Medicare-based revenue when they do
the following:
 Aggregate and analyze data
 Align financial incentives between payers
and providers
 Engage patients in behavior or lifestyle
modifications
 Garner support from clinicians and
encourage them to lead the shift to VBC.

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
Use Population Health Management as a Path to Value
As VBC definitions and goals continue to
shift, organizations can move forward using
population health management (PHM)
strategies as a path to value.
Population health is a data-driven strategy
focused on the proactive management of a
given population’s health by a defined network
of financially linked providers, achieved in
partnership with the community.

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
Use Population Health Management as a Path to Value
The PHM path to value includes working with
Medicare Advantage focusing on ambulatory,
not acute, care as it delivers more value;
leveraging registries based on utilization to
identify the most impactable 3 to 10 percent of
utilizers; and simplifying the physician burden
by focusing on reasonable measures.

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Shifting to Value-Based Care:
Four Ways to Balance Volume with Value
As health systems find themselves in different
phases of the journey from volume to value,
and policies continue to evolve, the industry’s
best stance on VBC is likely an agile one.
Organizations will need to sustain FFS
revenue while following guidelines and
strategies to be increasingly ready for VBC.

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More about this topic
Link to original article for a more in-depth discussion.
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