Dr. Laura Purdy: Building A Virtual Value-Based Care Plan
OpenLoop CMO, Dr. Laura Purdy, discusses what it takes to build a successful value-based care plan in telehealth
Recently, we sat down with our resident Chief Medical Officer (CMO), Dr. Laura Purdy to talk about what it will take for digital health companies to successfully transition to a value-based care (VBC) model.
Fee-for-service has been the name of the game for the last decade, but it’s time the healthcare industry, and digital health companies, look toward a future focused on better patient care and outcomes. In this interview, Dr. Purdy digs deeper into the industry transition to a VBC reimbursement model and the four key steps to think about when transitioning from fee-for-service.
The industry has seen a big shift from fee-for-service to value-based care. What does value-based care mean to you as a physician? Why is it important?
"The difference with value-based care is that the outcome or the quality of the care that’s being delivered is now factored into that equation, where it wasn’t before."
Historically, doctors always got paid for how much they did. When I think about what it used to be like, I think about things like RBUs (Reference Base Units). It used to be, “how many patients did you see”, “how many patients did you talk to”. There was no way of incentivizing or assessing whether what you were doing was making a difference.
Even when I was coming up from my medical education, I have such a vivid memory of being on my ICU rotation and watching the incentivist just right down diagnosis, diagnosis, diagnosis and that was how he was getting paid. He would have 20 or 25 different diagnoses for the patients. I remember thinking “that’s so silly that this patient has a history of acid reflux and this doctor just got paid by diagnosing them with acid reflux”.
The difference with value-based care is that the outcome or the quality of the care that’s being delivered is now factored into that equation, where it wasn’t before. So, the cool thing about what we’re calling “value-based care” is that it’s actually looking at the quality and the outcomes of what the doctor is doing. It’s essentially incentivizing doctors for doing a good job, not just doing a job.
What role does value-based care play in the future of healthcare? In more detail, how will it affect or benefit physicians and their patients?
When I think about telemedicine over the last decade or decade and a half, most telehealth has been cash pay and high volume prescribing. We have measured clinical quality with regard to “is what was prescribed safe and appropriate medically”.
But what we really haven’t done a good job of in the vast majority of telehealth is, a month from now, two months from now, a year from now, are we doing value-based telemedicine? Did we help the patient get better over the long term, did we improve their symptoms, did we prolong their mortality? Rather than just “did we safely prescribe”.
I think value-based care is going to represent the new era of digital health. I also think it’s going to represent, for doctors and for patients, a movement towards digital health. Not a full replacement of, but definitely exchanging a lot of that in-person care for virtual care. And doing it in a way that isn’t just as safe, but also just as good when it comes to those long-term outcomes.
What do you think are the key components or steps to building a successful value-based care plan?
"It’s going to be a total paradigm shift for all of the people who have worked in fee-for-service based telehealth for the last 10 years."
We are getting there. So how are we going to get there, right?
That’s a great question…I think the first step is going to be identifying those key players to have in your organization to help you do it successfully. Historically, because value-based care has not been a part of telehealth at all, a lot of the people that we would consider to be experts or experienced or in the telehealth industry are not going to have a background in implementing this.
And so, it will be really important to identify and put in place those people who have that skill set to be able to help with that adaptation.
Second of all, it will be important for telehealth companies to stand up compliance and quality departments. A lot of these cash pay, fee-for-service, high volume, pointy clicky companies don’t even have clinical quality or compliance departments in the way OpenLoop does with licensing and credentialing. That just doesn’t exist. I mean we have it, but a lot of companies don’t.
The third key is identifying the value-based metrics. CMS (Centers for Medicare and Medicaid) has some good guidelines if you look up the ACOs (Accountable Care Organizations). When CMS stood up their ACOs, there’s a lot of guidelines out there that are open source that you can access. So, find some guidelines on which to build your value-based care model.
The fourth is educating the value-based clinicians. A lot of doctors that are working in telehealth right now, especially on our OpenLoop platform, that have been doing this for five, six, seven, eight years, they would really have no idea what that means. We have to educate the clinicians and essentially get them to change their practice. It’s going to be a total paradigm shift for all of the people who have worked in fee-for-service based telehealth for the last 10 years.
For clinics and health systems, would you say that introducing telehealth is going to be essential to building a good value-based care plan?
I do think so, because one of the tenets, or I would say principles of value-based care is efficiency, and another one is cost reduction, not at the expense of quality. There’s nothing more efficient or cost effective for a lot of what we do than virtual care or digital health.
As the CMO of OpenLoop, how do you implement value-based care principles into our own services and clinicians?
At OpenLoop, the first thing that we’ve done is brought in key leaders from the brick-and-mortar industries that understand what it looks like.
Second, we have created a credentialing department and are working on creating a clinical quality department. With that, we are defining internally, with regard to insurance, payers, billing and reimbursement, what quality looks like as we move forward into this value-based revenue cycle. And how do we assess if what we are doing is good?
And the third thing is, we actively, continuously—I just had a phone call about what our top five metrics are that we want to develop. That is, these are the protocols that we’re developing and how we define success including; follow up, frequency of follow up and provider follow-up ratio. How do we take care of that?
The provider education piece, it’s harder to tackle, it really is. We have so many providers working with so many clients.
I’m really excited because we have this super robust clinical operations team that is coming up with just novel solutions and really creative ways to address these challenges that we’re finding as we move toward value-based care.
But one of the things I think OpenLoop has really done right is start to adopt and implement this so early in our life as a company. It’s perfect timing that as we’re growing and developing and expanding, to get into value-based care. It’s not so far gone that we’re having to totally disrupt everything that we’re doing. It’s a perfect time to create it.
Powering the future of value-based care
OpenLoop, a white-label telehealth support company, is constantly thinking about ways to move our patients, providers and clients into the future of healthcare. Implementing value-based care principles, like offering continuity of care, training value-based clinicians or offering cost-efficient services, are just some of the ways.
Interested in what our services can offer your organization? Get in touch here!
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Looking for more information on value-based care? Check out our other articles: “The Ins and Outs of Value-Based Care” or “The Migration from “Fee-For-Service” to “Value-Based Care”.