The Rise of Value-Based Healthcare
The shift from volume-based, fee-for-service healthcare to a value-based model that focuses heavily on quality outcomes has created a host of challenges for providers. While providers have always regarded high quality care as imperative, the ability to demonstrate improved outcomes through quality measure reporting is easier said than done.
Why is quality measure reporting so critical? In a recent study, payors predicted that traditional fee-for-service reimbursement will change dramatically over the next five years. By 2019, fee-for-service will represent about 30% of all contracts and the balance will consist of various value-based reimbursement programs such as pay for performance, bundled payment and global payments, among others.1
Central to all of these value-based contracts is the provider's ability to improve outcomes and report on quality goals set forth by the payor.
Technology Helps, But It's Not the Whole Story
Leaders of well-run medical practices recognize that true patient care has always involved holistic, in-depth knowledge of each patient's history, condition and status. Patient visits, to be truly impactful, must be understood and recorded in a way that enables every member of the medical team to understand patient needs over time.
New technologies, with their dashboards, databases, and ease of use, are tools to support such quality care. But without expert coaching on how to fully maximize their power, providers will be hard pressed to meet quality goals.
Two key aspects worth consideration are the importance of understanding EHR data fields. A complete and accurate set of patient data is crucial to practice performance and quality metric reporting. Secondly, providers should consider a "single sign-on technology," so they are not burdened by logging into multiple applications.
Three Ways to Leverage Health Information Technology
1) Coordinated Care for Each Patient: Data which is well organized and easily accessible means that the entire patient team is well informed about the condition and needs of each patient.During any patient encounter, the care team should have access to evidence-based, decision-support tools and a longtitudinal care plan that allows coordination of the right care, in the right place, at the right time.
2) Quality Gap Closure: Tools that provide views of the patient and entire practice population allow providers to focus on at-risk populations or identify patients due for essential screenings, such as mammograms, and drive intervention strategies.
3) Detailed Reporting to Payors: In addition to the clinical value of electronic records, medical practices must have access to detailed data to report to payors according to increasingly demanding outcome metrics.It is no longer enough to simply document application of the HbA1c test. Instead, payors may reimburse a reduced amount for HbA1c results above or below a certain level.
Learn more by downloading our free whitepaper: "Electronic Health Records and Quality Metrics: Using the right expertise to make full and meaningful use of your EHR investment."
To discuss how Continuum can empower your value-based reporting strategy, please contact: Devon Swanson, (856) 782-3300 ext. 2419 or [email protected]
1 The State of Value-Based Reimbursement and theTransition from Volume to Value in 2014, OCR International