Value-based care requires a thriving community-based healthcare ecosystem

By Jessica Sweeney-Platt | October 2, 2023

Healthcare Ecosystem

As healthcare continues its evolution to value-based care, it is more important than ever for patients to be engaged, active participants in their care. It is more important than ever for providers across the continuum of care to share data and coordinate care. It is more important than ever that patients can easily access care when and where they need it, and that their healthcare data follow them, eliminating the friction from receiving preventive and acute care.

A thriving ecosystem of community-based healthcare providers is critical to that vision.

What is a community-based healthcare ecosystem?

At its core, the community-based model begins with primary care, which means every patient has — and engages with — a primary care provider. This builds on the concept of the patient-centered medical home (PCMH) with primary care as the first point of contact for any medical concern a patient may have.

A truly thriving ecosystem, however, will have lots of points of access, offering patients that meet different needs and functions. Preventive and acute care should be available in locations that are easy to get to, near where patients live, work, or play. Evening and weekend appointments should be available close by, either in person or virtually. Specialists should be readily accessible both in terms of physical and digital proximity, as well as network integration. And patients should have easy access to non-clinical support services like nutritionists and home-health aides.

After all, what would you want for yourself or a loved one? A long drive to a downtown medical center with expensive parking, 9-to-5 hours, and long waits for an appointment? Or a visit with a provider in your town or even your own home, with convenient appointments and prescriptions sent directly to your neighborhood pharmacy? A community-based ecosystem is the natural evolution of the ambulatory-first trend in healthcare, which offers patients lower cost, more convenience, and increasingly personalized care.

A thriving community-based ecosystem will include more than small, local practices. It can and should include local clinics owned by large health systems, affiliated practices, urgent care centers, ambulatory surgery centers, and small- to medium-sized independent primary care and specialty practices. A strong healthcare ecosystem includes many outlets and models of care, allowing patients and providers to choose the approach that works best for them, supported by tools and information-sharing that help all practices thrive.

What makes a community-based ecosystem sustainable?

Value-based care is essential to ensuring that a community-based ecosystem is financially, clinically, and operationally sustainable for any size or type of practice. And there are additional elements that enable diverse community-based providers to offer high-quality care across care settings (even when those settings are not part of the same organization).

First and foremost, it’s crucial that providers have all the clinical information they need about their patients. They need visibility into care provided elsewhere, specialist notes, medication adherence, critical care gaps, and more. And they need that information to be filtered and curated to clearly show what they most need to know about the patient in a particular moment of care. This kind of experiential interoperability requires true data integration between hospitals, ambulatory care, and payers. This coordination across the continuum of care will be vital to the success of community-based medicine.

Community-based care providers also need to manage quality and quality reporting. But the value-based care landscape is getting more and more complex. CMS program requirements change each year. Medicare Advantage benefits and reimbursement models evolve. Quality targets and reporting requirements vary from payer to payer. Many large health systems employ entire teams to track and meet these changing expectations to protect their financial performance under value-based care. Many smaller practices don’t have the technical or human resources to do the same. In both cases, there is a tremendous administrative burden on the organization.

So, for a community-based ecosystem to truly thrive, practices need tools that automate much of the work of complying with value-based care requirements, as well as partners who take on that work at scale, simplifying the lives of clinicians and staff and letting them focus on what matters most: taking care of patients.

What does it look like when a community-based ecosystem thrives?

In the ideal, a community-based ecosystem is the lifeblood of value-based care, removing barriers to preventative care and keeping patients, especially chronically ill patients, highly engaged in their care and their health.

When patients can choose where and when to receive care, with a provider who makes them feel comfortable, they are naturally more likely to seek care when they need it. They can build an ongoing relationship with a primary care provider (PCP) and a medical home. And primary care, with its focus on prevention and early intervention, has been shown to increase life expectancy and lower overall healthcare costs — one study found that for every $1 spent on primary care, $13 are saved in downstream healthcare costs.

Convenient, patient-centered care makes it easy for the sickest patients to check in frequently with members of their care team, such as NPs or care managers, who can help triage issues before they require a visit to the emergency room or hospitalization.

In a connected healthcare ecosystem, patient information is truly integrated across the care continuum, reducing fragmentation, and facilitating care coordination. It also lays the foundation for integrating health-related information from non-traditional sources like community-based organizations, schools, and pharmacies. Health screenings and check-ins could be pushed out into the community in innovative ways — e.g., measuring blood pressure in the barber shop or doing home safety checks for the elderly — allowing care teams to better address social determinants of health. Without addressing these upstream drivers of health, value-based care can’t really succeed.

And with providers and administrators drawn from the local community, care can be more culturally responsive, offering care in the patient’s own language or recommending dietary changes that reflect cultural norms. And providers can choose how they prefer to offer care — as independent practitioners, members of a management services organization, full employees of a larger health system — and still succeed financially, especially in value-based care.

The impact on patients is better health, more choice, and truly patient-centered care close at hand whenever they need it.