Many nurses spend their days torn between competing priorities, but value-based care (VBC) may change that. VBC emerged as a model of Medicare and Medicaid reimbursement designed to replace the fee-for-service (FFS) payment model but has since evolved into a care model focused squarely on patients. How widespread VBC implementation will impact nursing isn’t entirely clear, but nurses make up the largest segment of the health care workforce and should pay particular attention to trends in value-based care implementation for two main reasons.
First, widespread adoption of the model will almost certainly have a major impact on how nurses train, practice, and lead, so nurses need to be ready to take an active role in guiding the transition from FFS to VBC. And second, it’s highly likely that nurse leaders will be instrumental in facilitating the shift toward VBC because a growing body of research shows that effective nurse leadership has a profound impact on health care systems. Relational nursing leadership, in particular, correlates with better quality care and better outcomes — two of the hallmarks of VBC.
If you want to help your organization integrate value-based nursing care strategies into an existing system or make the switch to VBC, you need to be ready. Studying leadership, decision-making, and transformation in the University of Michigan School of Nursing’s Online MSN in Leadership, Analytics, and Innovation program is a good first step. From there, you’ll need to assess whether your team, department, or organization has the resources and the outlook necessary to implement VBC.
What Exactly Is Value-Based Care?
Value-based care, which is sometimes called accountable care, is an alternative form of reimbursement that ties payments for care delivery to the quality of care provided instead of the amount and type of services delivered or resources used. VBC has three primary goals, often referred to as the triple aim: better care for individuals, improved public health, and lower costs. It works because value-based care programs reward nurses, doctors, and other health care providers with incentive payments when they provide exceptional service to their patients.
VBC has grown into not just a model of reimbursement but also a care management framework because unlike traditional reimbursement models, it doesn’t incentivize tests, procedures, or seeing as many patients as possible. It acknowledges that higher health care costs don’t lead to better outcomes and that provider workflows designed to maximize throughput can lower quality of care. Instead, the VBC model rewards providers in various care settings for effectiveness and prioritizes patient satisfaction and patient outcomes. To ensure continuous quality improvement, it asks providers to use informatics and health analytics to track quantifiable metrics (e.g., the frequency of hospital readmissions). It also promotes the kind of collaborative partnerships among providers, administrators, and patients that drive down costs while improving standards of care.
How Does Value-Based Care Affect Nursing?
Nursing has always embodied the principles of VBC but as more health care organizations implement value-based standards, nurses may experience several ups and downs.
Nurses benefit when organizations adopt value-based nursing care strategies because VBC lets them prioritize keeping patients healthy instead of seeing as many patients as possible. Nurses can share more health education with patients and spend more time explaining post-discharge care (potentially reducing post-surgical complications and hospital readmissions). Value-based care can also have a positive impact on nurses’ work environments, and there’s a quantifiable trickle-down effect. When nurses can focus on fewer patients per shift, work fewer overtime hours, and spend more time with each patient, patient outcomes improve. VBC also reduces the risk of nursing burnout.
Certain value-based nursing care strategies can add to nurses’ workloads and job stress, however. For instance, documentation is a major element of VBC, but nurses already spend between 26% and 41% of their time on documentation (versus 34% of their time with patients). Decision-making is another important element of VBC. Nurses are responsible for getting patients back to their pre-hospitalization baseline faster but not so soon they have complications, which can be exceedingly challenging. In both cases, effective nurse leadership can make adjusting to value-based care easier.
The Role of Nurses and Nurse Leaders in Implementing VBC
Adopting VBC principles may be easier for nurse leaders compared to other clinicians and health care administrators because as the American Association of Colleges of Nursing (AACN) asserts, “Nursing’s professional lens has always encompassed a cost-effective approach to health care without sacrificing quality.” Nurse leaders make what good nurses do possible by fostering organizational cultures that align with value-based care principles.
Nurse leaders have several roles to play in VBC implementation. They can help expand the scope of advanced practice registered nurses’ practice across the U.S., which can reduce costs and expand access to care. The Future of Nursing, a report funded by the Robert Wood Johnson Foundation, found that allowing APRNs to practice to the full extent of their education and training would lessen the burden on providers in other areas of medicine. That, in turn, could make implementing value-based care strategies in primary care and hospital settings easier.
Value-based nursing care strategies include the creation of a culture of health, and nurses are vital to the realization of this goal because they spend more time with patients than other health care providers. Nurse leaders can facilitate improvements in population health by giving their staff the tools they need to encourage healthy lifestyles in their patients and give equal time to the social determinants of health.
Nurse leaders can spearhead team-based care coordination, either as managers or nurse navigators. The American Nurses Association (ANA) defines care coordination as “a function that helps ensure that the patient’s needs and preferences are met over time with respect to health services and information sharing across people, functions, and sites.” Nurses are “uniquely positioned to coordinate care” because they work closely with patients and their families, other patient-care providers, and non-clinical specialists like social workers.
Nurse leaders also serve as staff advocates and overcome barriers to the implementation of value-based nursing care strategies in the process. They can, for example, ensure electronic health record systems are supporting care instead of driving it by choosing technologies and processes that make documentation and data collection easier for nurses. They can empower their staff to make confident data-driven decisions. They can encourage the kind of functional teamwork that contributes to clinician well-being and resilience. And nurse leaders can ensure nurse-to-patient ratios are appropriate, improving both nurse wellbeing and patient safety.
Is your Team or Department Ready for Value-Based Nursing Care?
Implementing value-based nursing care strategies is a step-by-step process. Step one is preparing for the changes VBC will bring about by assessing team-wide, departmental, and facility-wide readiness. To determine whether your team or department is ready to implement value-based nursing care strategies:
Look at departments, teams, service lines, and revenue streams — How do nurses, other providers, and administrators handle case management, documentation, staffing, operations, and change management? Is there room for improvement?
Identify processes and goals already in alignment with VBC — How are staff and management already meeting VBC goals? Consider how adopting value-based care strategies will impact your organization.
Launch a VBC education program — Make sure all providers, technicians, support staff, and administrators are aware of not only the requirements and goals of value-based health care but also the benefits.
Create measurable first-round benchmarks — Fulfilling the requirements of VBC means being able to provide evidence that each of your quality indicators correlates with improved health outcomes. Think about what kinds of data can best showcase your successes.
Update EHR technology — VBC implementation involves capturing, processing, analyzing, and reporting on a wide range of clinical and non-clinical data, and most legacy EHR systems aren’t equipped to do things like communicating with other systems or tracking specific metrics.
Work to meet outstanding staffing needs — Do you have the RNs, LPNs, and CNAs you need? Adequate staffing is a key part of value-based care delivery. Short staffing is incompatible with VBC.
Create a plan of continuous improvement — Value-based care requires regular monitoring, feedback, and process adjustments. What works in today’s health care climate may not be effective in the future.
Preparing Yourself to Thrive in a Value-Based Care Environment
Successfully implementing value-based nursing care strategies requires making changes at both the organizational level and the individual level. If your organization isn’t ready to adopt VBC at this time, you can still prepare yourself for what is likely an inevitable transition to value-based care because the data suggests VBC works. A national study commissioned by Change Healthcare and conducted by ORC International found that value-based health care not only reduces costs by up to 7.5% but also improves care quality, patient engagement, and provider-patient relationships.
VBC is also replacing fee-for-service faster than anticipated, which is another reason to look at your readiness. You can do this by:
Knowing your patients — Understanding the factors that drive emergency department utilization, hospital readmission, and patient disengagement can help you identify opportunities to implement VBC strategies in your own work.
Partnering with other providers — Studies suggest that when RNs and APRNs coordinate care with doctors, specialists, urgent care centers, insurers, and allied health professionals, they accomplish many of the goals of VBC — even when it’s not official policy.
Skilling up — Data analytics is at the heart of value-based health care. Be sure you know how to collect and track the right data for your patients and report outcomes. If you can use health informatics principles to drive actions that ignite lasting positive change in your organization, even better.
Studying leadership — If you have your BSN and are ready to move health care forward and help your organization embrace a patient-first philosophy, now is the time to apply for the University of Michigan’s Online MSN in Leadership, Analytics, and Innovation program. It trains and educates adaptive and flexible nurse leaders who can be proactive about building value in the face of change.
As a U-M MSN graduate, you’ll have the skills and knowledge to lead cross-functional care teams, improve nursing processes, educate and empower nurses, shape health policies, and implement VBC strategies in your organization. You’ll also have a degree that opens doors leading to a wide range of opportunities in nursing leadership, including nurse manager, health care team leader, or Chief Nursing Officer (CNO). If you’re not in a position to implement value-based care today, you can ready yourself to be a leader in the transition to VBC in just two years of part-time study.
Learn more about U-M’s Online Master of Science in Nursing in Leadership, Analytics and Innovation program admissions criteria, graduate financial aid, or the MSN student experience by reaching out or registering for an upcoming enrollment information event. When you’re ready to take the next step in your nursing leadership journey, apply online.