A. Decision-Makers and Stakeholders ID physicians interested in participating in value-based programs, implementing value-based measures as a component of compensation or being recognized for contributing to an institution’s success in value-based and pay-for-performance programs first need to assess who the key decision-makers and stakeholders are for these topics in their institution. To do so, ID physicians should engage other specialists in their organization who participate in value-based arrangements or have compensation tied to value-based metrics and measures to understand their success stories and processes. Because value-based concepts remain relatively nascent, organizations may have unique approaches to the concepts and may include different stakeholders in decision-making. Additionally, ID physicians will need to be aware of the potential value-based contracts that are active within other specialties and consider ways to mitigate direct competition with these specialties for funding.

Hospitals and health systems bear significant economic risk for achieving certain measures. Therefore, ID physicians should identify who in the institution’s leadership structure is held accountable for performance in pay-for-performance programs. That person can be an ID physician’s strongest advocate for realigning compensation with the value of ID services, if the institution’s performance in those programs is influenced by ID activities.

B. Case Study: Primary Care While value-related reimbursement concepts tailored to primary care are not perfectly reflective of the opportunity that exists for ID physicians, there are some lessons to be learned from primary care organizations that have thrived in a value-based care setting and have developed the various tools to succeed at scale. Put simply, these thriving organizations have built the care team so that the primary care physician can extend their reach and deploy care coordination efforts to ensure patients with chronic conditions are on the appropriate care pathway. The tracking mechanisms put in place decrease the number of patients who fall through the cracks and increase patient-provider engagement. ID physicians tend to engage in activities (complex care coordination, protocol management and development, quality initiatives oversight, etc.) that influence outcomes, even if they are not all patient facing or revenue generating.

Primary care organizations also monitor and coordinate patient medications, especially for patients with comorbidities. The most successful organizations have partnered primary care physicians with pharmacists to help with medication monitoring efforts and to optimize clinical therapies. OPAT is an example of a service ID physicians provide that also demonstrates the value of collaborating with pharmacists.

Lastly, many primary care organizations have implemented patient referral tracking technology. In an era where interoperability among electronic health records is scarce, these systems can serve not only as tracking tools but also as communication platforms for specialists to connect with patients’ primary care physicians. These tools have reduced redundant treatment and enhanced the patient experience while strengthening the patient-provider relationship.

An ID physician’s OPAT activities for risk mitigation by treating complications, communicating with patients and families, and coordinating care among generalists and other specialists similarly are intended to improve outcomes and reduce redundant or unnecessary treatment. Additionally, OPAT is an example of an activity that can decrease emergency department visits, readmissions and treatment complications, which result in care cost avoidance and a possible opportunity for shared savings. Based on these possible results, OPAT is a potential value-based model that can be negotiated with institutions and payers.

C. Bundled Payments Bundled payments are a form of value-based reimbursement in which a single payment covers all the health care services provided during an episode of care. Episodes of care are defined as the paths from patients’ initial diagnosis to their long-term health outcome. The objective of bundled payments is to promote an efficient use of resources while improving quality and care coordination. If the total cost of care of an episode is less than the associated bundled payment, the participating providers keep the difference. However, if the total cost exceeds the payment, providers realize an economic loss. In some cases, employed physicians may receive bundled payment distributions from institutions and payers based on their participation in the episode of care.

Bundled payments demonstrate that quality is not the sole driver in value-related payment concepts. Rather, value is a function of quality and cost. For example, through the appropriate deployment of resources, diagnostics and medical and surgical care, the overall cost of a single episode of care can be effectively managed while maintaining or possibly improving quality. Bundled payment programs are intended to incentivize providers to coordinate patient care with this cost reduction in mind. While quality initiatives that focus only on patient outcomes are important, bundled payment programs are an example of how cost is a key part of the value equation.

While there may not be existing arrangements tailored to ID, some bundled payment programs represent opportunities for ID physicians to highlight and capture the value of their services within an episode of care, such as the Comprehensive Care for Joint Replacement Model. The model requires collaboration among various specialties, including ID physicians who prevent and treat postoperative infections. If an ID physician’s institution does not participate in bundled payment programs, the same concepts can be implemented as a component of compensation or hospital-to-physician reimbursement (e.g., private practice contracting with the hospital).