Communication is more important than ever in a value-based care system

December 18, 2018 - by Talya Meyers


You may love it or hate it. You may still be fuzzy on what it actually means. But there’s no question that value-based care plays a growing role in the healthcare industry.

Rangaraj Ramanujam is a professor of Management at Vanderbilt University, where he studies the effect of provider communication on patient safety. “Value, plain and simple, is patient outcomes per dollar spent,” he said.

There’s reason to embrace the concept. A brand-new report from Humana found that patients in a value-based care setting were more likely to have preventative screenings, manage chronic conditions, and adhere to medication regimes. They were also less likely to visit the emergency room or be admitted to the hospital.

Humana’s report is well in keeping with the main goal of value-based healthcare: to ensure that healthcare providers are paid for the quality of the care their patients receive, rather than the volume of the medical services they provide.

Finding the “value” in value-based care

But what constitutes high-quality care, and who decides? It’s a complex question, but according to Ramanujam and to Denise Kennedy, a clinical assistant professor at Arizona State University’s College of Health Solutions, patients are an increasingly important part of how “value” is determined. “Satisfaction surveying has been part of health care for many years, but today it’s taken on even greater importance,” Kennedy said. “First and foremost, we measure patient satisfaction to understand and improve the overall experience.  It’s the right thing to do for our patients. Secondly, in value-based payment models, patient satisfaction data impact an organization’s revenue.”

How are we delivering on value? It’s through people. And if that’s getting lost, any pursuit of value is not going to be sustainable.

— Tim Vogus
Professor of Management, Vanderbilt University

For example, the Centers for Medicare and Medicaid Services’ (CMS) Hospital Value-Based Purchasing Program, which emerged out of the Affordable Care Act, is designed to improve healthcare quality and the patient experience. The reimbursement a hospital receives from CMS  depends in part on its scores on the best-known patient satisfaction survey, the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). “One goal of the Affordable Care Act was to create a more consumer-driven healthcare purchasing experience,” Kennedy said. To that end, she explained, CMS has made hospitals’ patient satisfaction scores—along with mortality and infection rates, and a number of other quality measures—publicly available to patients. “All of that information, as well as paying more out of your own pocket, helps you as a consumer make better healthcare decisions and spend your dollars more wisely. The end result, hopefully, is to provide higher quality care at a lower cost.”

Communication’s role

But what, exactly, will make for satisfying patient experiences? Ramanujam says that healthcare providers often focus their efforts incorrectly. “Doctors think patients are going to be more satisfied if the process is efficient. And yet when you talk to patients, one of their expectations is, ‘We would rather spend more time with the provider, talking about our condition and learning more about it,’” he said. “It seems like it’s about time, but it’s really about communication.”

And studies have repeatedly shown that good communication—from doctors and other medical staff—is vital to patient satisfaction. Effective communication even leads to better patient outcomes, a major feature of value-based care evaluations.

While traditional research has focused primarily on doctor-patient communication, Kennedy pointed out that responsiveness and empathy from non-clinical staff—mainstays in customer service—are particularly important in stressful healthcare settings. “Staff who work in housekeeping or appointment scheduling also are on the front line interacting with patients. They have many opportunities to connect, improve the overall patient experience, and impact the financial health of the organization long-term,” she said.

In addition, a 2016 Accenture report found that 51% of patients would switch healthcare providers to receive great customer service. And a 2016 study found that 96% of online patient complaints are related to quality of service, rather than medical care. (53% of those, the largest category of complaint, were about communications issues.)

Putting it all together

“How are we delivering on value? It’s through people,” said Tim Vogus, a professor of Management at Vanderbilt who studies the importance of compassionate behavior—towards both patients and staff—in healthcare organizations. “And if that’s getting lost, any pursuit of value is not going to be sustainable.”

We may understand that patient satisfaction figures into the complex calculation of value, but that doesn’t mean that we’re working to satisfy patients in the most efficient ways. Patients want to be healthy, of course, but they also want to be heard and understood. They want to be treated with courtesy and attention. And they want clear, empathic communication from their healthcare organizations. “It’s not necessarily more attention than we should have been paying all along,” Vogus said. “If you want to deliver high-quality care, it was always essential.”


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