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In Brief: In part three of our ongoing series on value-based care (VBC), 我们探讨了云顶集团40011官网企业如何通过有效的人员配置基础设施来实施他们的VBC计划.
At its heart, healthcare is about people taking care of people, 提供者和支持人员是任何医疗实践的命脉. 卫生保健工作者被一种为他人云顶集团的愿望所召唤.
VBC通过将支付与这些人照顾他人的成功程度挂钩,为实现这一愿景提供了一条途径. 通过重新配置供应商组织内的支持人员基础设施,创造性地思考负责任的云顶集团40011官网企业的患者群体及其需求, 一种以团队为基础的护理模式出现了——一种与患者和护理人员合作以获得高质量结果的模式. 设计和操作该模型是组织在向价值过渡过程中取得成功的关键.
Aligning Your VBC Goals with Your Patients and Practice
向VBC过渡的第一个原则是了解您的患者分组及其人口统计数据, along with your practice’s value-based goals, and then align support staff accordingly.
Staffing dollars are limited, 每个新角色都必须仔细评估,以确保它适合组织. 以下几个关键问题将为基于价值的人员配置基础设施的规划提供信息:
1. 您如何描述您目前和计划中的未来患者群体, 这一人群是否有你打算通过VBC来解决的主要特征?
- 主要是老年人口,伴有社会和/或医疗问题
- 这一人群在医学上很复杂,有接受诸如住院等高成本医疗事件的风险, readmissions, and/or ED utilization
- 有高药物使用率和行为健康问题的人群
- Patients with high rates of social needs and/or limited finances
- A mix of patients and needs, 在哪里,实践的重点是为广泛的人群提供不同类型的护理
2. What is your current payer landscape and strategy, and how is it expected to change over the next three to five years? 你们希望在即将到来的付费合同中体验到什么?
- 向财政和人口保健过渡,更加强调利用(例如.g., PCP visits per 1,000) or health maintenance activities (e.g., cancer screening rates)
- An increasing number of patients enrolled in Medicare Advantage, managed Medicaid, and value-focused commercial plans
- Adherence to evidence-based care for key clinical conditions (e.g., diabetes, heart failure)
- Accountability for outcomes and care outside your practice (e.g., all-cause readmissions rates, SNF to admissions)
3. 在您的临床操作中,哪些领域有机会使您能够实现VBC交付?
- 患者可及性,包括足够数量的紧急、当日或次日就诊
- 患者对临床筛查建议的依从性和转诊的后续跟进, 其中包括将患者与社会工作和行为健康云顶集团联系起来
- 总体操作吞吐量、等待时间和护理导航功能
Building the Right Staffing Infrastructure
为了支持VBC转换,将需要新的技能集和支持人员. 不同的组织会有不同的头衔,但通常这些职能包括:
- Complex Care Management: Depending on the patient population and VBC focus, complex care managers will generally be either social workers or nurses. Their role is to help manage high-risk patients and, importantly, patients at risk of becoming complex in the outpatient environment, in order to minimize avoidable ED or inpatient stays.
- Panel Navigation重点关注筛查率和对循证方案的遵守情况, managing the patient panel takes on greater importance. A panel navigator, panel manager, or outreach coordinator, 谁可以是训练有素的外行或医疗助理,如果有临床证书优先, conducts both inreach and outreach. Like outreach, inreach may be focused on particular campaigns (e.g., flu shots), general health maintenance (e.g., a patient who is due for a colonoscopy), or reaching a screening threshold for the clinic or physician (e.g.例如,云顶集团40011官网需要为他们的人群进行两次以上的乳房x光检查才能达到他们的质量目标)。.
- Ambulatory Pharmacy: The clinical, ambulatory, 或人口健康药剂师参与照顾复杂和风险上升的病人. 药剂师将发挥关键作用,并将重点放在他们指定人群的药物管理上, including prescription adherence, medication reviews and patient education, identification of cost-effective alternatives, and management between visits. In a traditional model, a provider may consult with a pharmacist on occasion, 而在VBC,药剂师完全融入到护理团队中.
- Behavioral Health and Social Work: This may be a licensed therapist, substance use counselor, social worker, or related role, depending on the social needs of the practice’s patients. In some organizations, there may be significant social and behavioral health needs, and the team may include more than one caregiver. Typically, 这些团队成员将得到精神科云顶集团40011官网或心理学家的支持,他们可以将更复杂的病人转介给他们,或者从他们那里获得电子咨询.
Source: Medication Management | Improving Primary Care Team Guide
与人员配置有关的最后一个考虑是支助人员如何以及在哪里工作. 虽然远程工作和集中化在员工和雇主中都很受欢迎, there must be a balance to ensure team dynamics are maintained. As the care team grows, 凝聚力和角色清晰度对于确保每个团队成员都知道并履行他们的角色和完成所有任务至关重要. 使用标准化的工作流程将允许所有护理团队成员了解他们在整个诊所环境中的角色. Team-based care 对于许多实践来说是一个新概念,并且需要灵活性和理解才能实现.
Staff Redesign for VBC
向价值的转变使提供者能够全面地照顾患者, 不仅帮助解决他们的医疗状况,还帮助解决他们的社会和个人需求. 这需要对现有的人员配置基础结构进行战略性的彻底检查——您的组织将有新的工作要完成, requiring new skill sets. 对现有的支持人员和技能进行详细的审查,以确定可以从内部发展的能力和需要创建的新角色, such as care coordination, triaging, and value-based documentation skills. 为VBC设计的有效的员工基础设施将使组织在基于价值的合同安排下取得成功, whether those are shared savings, quality bonuses, or capitation arrangements.
What’s Next?
In the final post in our value-based care series, we will explore the importance of optimized IT, EHR, and analytical tools for value-based care.
云顶集团,获得专家指导,指导您的组织建立基于价值的护理人员配置模式.
Edited by: Matt Maslin