How to talk to patients about value-based care

The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

As a healthcare provider, you’ve seen the benefits of experimental models, value-based care and artificial intelligence to your practice and your patients. But communicating those benefits to your patients can be a different story. Here’s how you can discuss these different care models and tools with your patients.

Why the ACO REACH model is better for patients

Medicare with its different options and parts—A, B, C and D can be confusing. And the new ACO REACH model can be difficult for anyone to understand. Your patients don’t need to know the ins and outs of the model; all you need to do is show them how it can make a difference to their daily health and wellness in ways Traditional Medicare or even Medicare Supplement or a prescription drug plan can’t. Make the benefits to them concrete so they’re easy to visualize. Here are some examples how ACO REACH can help them:

White-glove service. Explain how, with ACO REACH, they get assistance scheduling appointments and rides to the doctor, which eliminates stress and removes barriers. They’ll be able to see their doctor once a quarter, not just once a year, to help catch any emerging issues early. Plus, they’ll get help managing their health at home and adhering to treatment plans.

Multiple support teams. Let your patients know about the different support teams available with ACO REACH. First, there’s a case-management teamwith nurses on staff to manage short-term and long-term needs. Our short-term team helps patients transition to being home after getting out of the hospital. The long-term team helps patients with chronic conditions adhere to their treatment plans. 

They can also take advantage of a social worker team to support members with social determinants of health issues. For example, if they’re struggling with food insecurity or financial issues, the team can help them find resources like food banks, meal delivery or assistance with bills. Finally, a member-outreach team sets up appointments and arranges for transportation to the doctor.  

$0 copays for primary care visits. Let your patients know about the financial benefits of ACO REACH. Beneficiaries don’t have to pay the 20% co-insurance fee of Traditional Medicare.

How to explain the benefits of value-based care

According to a survey by USofCare, people want a care system that prioritizes the quality of patient experience, rather than the quantity of care. But most people are not familiar with the term “value-based care,” and they don’t connect it to a higher-quality patient experience.

“People love the promise of value-based care. They love the prospect of spending more time with their doctors, providers communicating with each other directly and patients being treated as a whole person, instead of a collection of symptoms,” Natalie Davis, USofCare co-founder and CEO said. “However, no one understands what ‘value-based care’ is, and the term can make you think of cheaper and lesser quality services.”

As a provider, you can help patients understand what value-based care is and how it can work for them. To start, you might want to change what you call it. According to the survey, people responded better to the terms “quality-focused care” and “patient-first care.”

Let patients know that the ACO REACH model focuses on whole-person health, inside and outside the exam room. As we mentioned, this model provides a team to help them get to the doctor, address their needs outside of the doctor’s office and help them stay on a treatment plan. It was designed to improve health outcomes and ensure everyone has access to quality care, regardless of their circumstances or socioeconomic background.

Patients may have questions about how this care model would work in practice. Will it be more expensive or cause issues being able to get into their provider? Make it clear that addressing health issues before they become larger problems decreases costs over the long term. With value-based care, providers address the root cause of an issue instead of putting a temporary band-aid over it.

For example, a patient kept going to the ER because of respiratory problems. Her provider and team dug deeper into the situation and discovered a pest infestation in her home. The pests were removed, and her respiratory issues improved. Spending time to understand the root of her issue helped the patient and prevented more expensive ER visits.

Sometimes using an analogy to help your patients understand how value-based care works. For example, the way maintaining your car can prevent costly repairs down the road, value-based care can help patients avoid expensive healthcare issues down the line.

When talking about value-based care, keep the message simple. Focus on how this care model will improve the patient’s experience, including:

– Seeing their provider once a quarter instead yearly, or when problems arise, can help catch health issues before they become worse.

– Support from case management and social work teams can make it easier to stay on track and address issues that may be impacting a patient’s health.

– Help navigating the system and adhering to treatment plans results in better patient experience and outcomes.

Discussing artificial intelligence with your patients

Like many other industries, healthcare is using artificial intelligence (AI) to improve their processes. But seniors are skeptical of AI. According to Deft research, more than 80% expressed doubt over AI’s accuracy and truthfulness.

Currently, seniors don’t see a place for AI in medical care. According to research, 64% say they don’t want AI involved in medical claims, and 60% don’t believe it can help doctors improve their diagnostics. But the healthcare industry is already seeing the benefits; AI has improved diagnostic reading accuracy.

Reframing the narrative on AI can help seniors understand it better. Explaining that AI works as an office assistant or another tool to help with basic tasks, can make it easier for them to see the value. When discussing technology using terms like data analytics, data-informed or technology-assisted could be more palatable for seniors.

We’re just beginning to see how AI can help enhance healthcare. To take advantage of the possibilities for AI to reduce costs and make healthcare more efficient, people will need to get behind the technology. Pointing out how it can lower plan costs, provide a more seamless experience and help providers diagnose or find patient issues could help them see the benefits. AI can also make treatment pathways more efficient and effective.

Often, your patients won’t need to understand how AI works to improve their healthcare. For example, they don’t need to know how BrainStream works for it to improve their experience. Patients don’t care about the technology; they care about how it helps their healthcare outcomes. Focus on how the technology helps create a better care system, and how it allows providers to deepen relationships, build trust and offer more services to provide a better experience.

ilumed speaks your patients’ language

Helping patients understand the benefits of the ACO REACH model, value-based care and AI is just one more step to make these systems work. Check out our resources to find even more articles on the benefits of ACO REACH.

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