Lisa Eramo

Learning From the Navy’s Value-Based Care Implementation

Value-based care implementation is a top priority for today’s health care organizations, but many are unsure of how to complete the transition away from traditional fee-for-service models. To find best practices and proven strategies, health care leaders and others need look no further than the U.S. Navy.

In 2016, the Navy launched a value-based health care pilot project at Naval Hospital Jacksonville to determine whether health outcomes would improve with condition-specific, multidisciplinary care teams called integrated practice units (IPUs). The 12-month pilot project, which focused specifically on lower back pain, osteoarthritis, diabetes and high-risk pregnancy, was ultimately a success. A recent analysis indicates that not only did the project improve outcomes and lower costs, but it also actually had additional benefits such as decreased diagnosis time, reduced time spent in physical therapy and improved A1C scores.

This story serves as an example for how it’s possible to move the needle on value-based care, keep individuals at work and help people with health concerns return to work as quickly as possible.

Design of the Pilot Project

The pilot project was based on one relatively simple premise: Providers render care more effectively when they focus on team-based coordination.

Each IPU in the pilot was an “all-star team” led by a primary provider and nurse. Other members included multiple specialists — other physicians and nurses, nutritionists, mental and behavioral health specialists, pain management experts, nutritionists, physical therapists — as well as a care navigator. Together, the team became responsible for all of each patient’s care related to that condition, including outpatient care, inpatient care and any required support services.

According to NEJM Catalyst, at the launch of the effort the hospital held meetings to disseminate key concepts within value-based care to all hospital leaders, patient representatives and staff members. Throughout the project, each IPU met with patients together as a team, and then separately as individual providers, to better address patient goals. They also identified and tracked core metrics, including patient-reported outcomes measures, functional outcomes, process measures and quality measures.

The project targeted certain conditions connected to several striking statistics.

  • Twenty-one percent of patients diagnosed with a chronic condition have low back pain. Of these, 41% are active-duty personnel.
  • Ten percent of patients with a chronic condition have diabetes.
  • Four percent of patients with a chronic condition have osteoarthritis.

Results of the Project

The pilot project ended with several promising results that health care providers and others may be able to replicate on a larger scale.

  • Low back pain. Patients received a diagnosis in fewer than five days, a drop from the prior average of 13 days. They also spent 60% less time in physical therapy, and more than one-third had their symptoms completely end. Many patients also eliminated the use of morphine.
  • Diabetes. Patients decreased their hemoglobin A1C levels by an average of 2.5 percentage points.
  • Osteoarthritis. Average outcome scores for hip disabilities and knee injuries improved.
  • High-risk pregnancy. The majority of patients delivered at term. They were also more likely to use behavioral and nutritional health resources.

5 Main Lessons Learned

The Naval Hospital Jacksonville’s pilot program is filled with takeaways for providers. These lessons can ease efforts to transition to value-based care and improve value-based care statistics.

  1. Provide low-cost interventions. The low back pain IPU reduced costs by shifting treatment to physical therapy and exercise rather than morphine use, helping patients return to work more quickly.
  2. Go back to the basics. The diabetes IPU improved outcomes simply by organizing care more effectively — not by using new technology or advanced techniques.
  3. Narrow your focus. Concentrate on targeting high-volume conditions with existing evidence-based clinical pathways. Analysis of the study showed that the high-risk pregnancy IPU included a lot of variability and limited patient volumes, making it difficult to achieve more significant positive outcomes. According to the analysis, an IPU focused on normal pregnancies may have yielded more improvement.
  4. Communicate. Strong communication is key. Everyone involved needs to understand how value-based care works and why it matters.
  5. Involve care navigators. The pilot program found that care navigators took on the burden of care coordination, including managing patient intakes, gathering clinical information and coordinating IPU appointments. This is a critical role in the success of value-based care models.

While it’s still early days for projects like this one, and more are sure to follow, the results of the U.S. Navy’s pilot program are promising. Its value-based care implementation may be able to serve as a model for other organizations seeking to improve value-based statistics through higher-quality care.