People often have two desires for their health care services—low cost and high-quality care. OneCare Vermont is working to make that a reality. OneCare, as an accountable care organization, is focused on health care value—which means it is both accountable for the quality of care along with the cost of care. To incentivize healthcare providers to implement quality improvement measures that are proven to lead to better health and well-being outcomes, OneCare provides data and information to help providers focus their improvement activities and ties payments directly to quality measure performance.
“If you look at ways to help improve value in the healthcare system, quality is the foundation that we really want to invest in in order to take our already high-value care to the next level—which is harder in Vermont, we’re starting at an amazing starting point,” says Dr. Alicia Jacobs, practicing physician at Colchester Family Medicine, vice chair and associate professor in family medicine at the Larner College of Medicine at the University of Vermont, and physician liaison for OneCare Vermont.
Through its quality improvement support to providers and innovative payment structures, OneCare is helping participating providers move to a new payment structure—from one that rewards for seeing people more often and doing more procedures, which is how providers make more money in the fee-for-service payment model, to taking good care of a population of patients in a value-based care model.
While quality improvement measures are not new in healthcare, OneCare is building the infrastructure to support and monitor quality improvement efforts across the state. Over the past several years, OneCare has worked to align quality measures and incentives across payers (like Medicaid, Medicare, and commercial insurers) that OneCare contracts with on behalf of participating providers—and has selected four of those eighteen measures to provide clearer focus on priorities and to give additional financial incentive to high performing providers.
“We used to have like 30 quality metrics that we used to try to monitor and intervene on,” says Jacobs, “But the truth is, when we’re in the quality mindset, and even if we’re only working on two, it elevates the standard of your care across the board. We start thinking about choosing wisely, we start thinking about how to meet patient expectations and develop a treatment plan that will work for them.”
While the quality improvement measures OneCare focuses on will change over time based on the need of the population and performance by providers, the current measures tied to financial incentives include two for adults focused on management of diabetes and hypertension, and two for the pediatric population—developmental screenings for young children and depression screenings for adolescents.
Decreasing cost is not about limiting care, it’s about trying to prevent complications from happening.
An example of quality improvement in action is instituting interventions focused on diabetes, a very common condition that can have multiple complications that can be serious. Quality improvement interventions include reviewing reports of patients at-risk or overdue for care and using checklists to ensure providers are on top of care to manage diabetes and prevent complications. This may include ensuring annual eye exams to prevent or treat diabetic eye disease, foot exams to check for sensation and prevent foot infections, checking regular blood work to assess diabetes control, and urine tests to monitor for kidney damage.
“You don’t have to actually be doing a quality intervention on every single disease in medicine in order to actually do better on all of them,” says Jacobs, “Because we’re in a quality science mindset when we practice, it’s really now just an expected part of primary care—like it is what we eat, breathe and do. This is how we practice. It’s the foundation of value-based care.”
What is Value-Based Care?
Value-based care focuses on high quality care, how people experience health care, and health care results. It pays providers more when people’s health and the health of the community improves—often referred to as population health. Learn more here about how value-based care compares to traditional fee-for-service care, and what it means for patient.
Biography: Alicia Jacobs, MD
Alicia Jacobs, MD
Alicia Jacobs, MD is a practicing physician at Colchester Family Medicine, an associate professor in the Department of Family Medicine at the Larner College of Medicine at the University of Vermont (UVM), and a physician liaison for OneCare Vermont. Jacobs is currently the vice chair for Clinical Affairs in Family Medicine developing innovations in the UVM Medical Group including clinical care pathways, leadership development, and electronic medical record and healthcare delivery re-design. Jacobs spearheads many collaborative projects in the “medical home”—a team approach to providing comprehensive primary care—that push health equity and address social determinants of health including universal medication-assisted treatment, farm-to-patient nutrition, and exploring ways to provide trauma-informed care.
As physician liaison for OneCare, Jacobs works closely with OneCare’s chief medical officer (CMO) to advocate for continuous quality improvement and advance value-based health care models. With OneCare’s CMO, Jacobs improves communications between OneCare and UVM Health Network (UVMHN), aligning OneCare’s payment reform, data and analytics, quality, and care coordination supports with the UVMHN’s health care delivery system to improve the health of Vermonters.
About OneCare Vermont
OneCare Vermont partners with health care providers to transform the health care system to one that focuses on health goals and fosters better outcomes for all. By giving health care providers actionable data and analytics, paying for health care value, and managing ACO network performance, OneCare supports participating providers in their work to provide excellent health care to Vermonters. Through this partnership, OneCare moves Vermont toward a trusted, equitable health care system where patients and providers work together to achieve optimal health and an exceptional care experience.
For more information:
Please contact Public Affairs at OneCare Vermont. firstname.lastname@example.org | 802-847-1346.
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