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Comp sector might be ready for value-based care: Experts

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Comp sector might be ready for value-based care: Experts

BOSTON — An industry that is already focused on outcomes might be ready for value-based care, which pays providers based on successful outcomes and not traditional fee-for-service, according to a researcher who studied the workers compensation industry’s interest and readiness for a different model of paying for care.

“Valued-based care has been around (in health care) for more than a decade,” Dr. Randall Lea, chief medical officer of Alice Peck Memorial Hospital, a Dartmouth-Hitchcock Affiliate in Lebanon, New Hampshire, told attendees at the Workers Compensation Research Institute’s 24th annual Issues and Research Conference in Boston on Thursday. “It’s ill-defined and not well developed in comp… Stakeholders are unclear in how they are going to use it.”

But there’s interest, he said, spending 45 minutes presenting the findings of his recent survey of workers compensation stakeholders on the subject of introducing value-based care to injured workers and those who care for them. The industry is “thinking and ready for it,” he said.

The industry appears ready to “focus on quality instead of discounts,” he said, elaborating, “anything that encourages return to work, anything that is outcomes-focused.”

To gauge concerns, Mr. Lea Interviewed 29 workers comp stakeholders — seven providers, seven payers and 15 regulators — collecting more than 1,000 responses that painted a picture of the utility and possible execution of the health care model in comp. Of the providers interviewed, four are using value-based care for their Medicare and/or group health patients, but only one had seen it for a workers compensation patient. Regulators, representing nearly half of interview subjects, were “cautious” about value-based medicine and tended to asked more follow-up questions themselves about the topic. 

Only one regulator came from a jurisdiction that was participating in value-based care, which was structured around access, he said.

With the practice still in its infancy in workers compensation, the purpose of the study was to “start the conversation,” Dr. Lea told attendees, adding that some of the answers formulated around such open-ended questions as: Are you using or considering value-based care? What are your reasons for participating or lack thereof? And how you are considering it?

The major themes that came up during interviews was measuring outcomes, such as return to work, patient satisfaction or keeping the patient motived, and data-sharing and information technology, he said. 

“Patient centeredness is a foundational piece of the value-based model,” he said. “Patient satisfaction is a leading cause of litigation. …Providers are incentivized to return to work as soon as possible.”

One area that also drew some concern was provider choice, with most if not all respondents saying that employer-selected providers had to be a part of the equation, he said.

Providers, in turn, wanted to eliminate fee schedules. Of physician incentives for participating in value-based care, “financial is still the strongest,” Dr. Lea said. Data-sharing is another plus, he said. “They all want trusted data source.”

Dr. Lea said he hopes to see the approach take off. 

“The real question is, will the value-based care model in group health and Medicare become a reality in comp?” he said. “Workers comp is the only group that has return to work… which is a clear indicator for health. That’s something to think about.”

 

 

 

 

 

 

 

 

 

 

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