Value-Based Care News

3 Strategies to Follow in Value-Based Care Reimbursement

When incorporating value-based care reimbursement, bringing in the right technology, population health data analysis, and risk-based contracts will be imperative for a successful venture.

By Vera Gruessner

In order to have an effective value-based care reimbursement strategy, healthcare payers and providers will need to implement a number of steps in their pursuit of rewarding quality of care instead of quantity as seen in fee-for-service payment systems. Below we will outline the top three necessities for developing value-based care reimbursement protocols.

Accountable Care Organizations

Adopt the right technology

When it comes to value-based care reimbursement, a hand-in-hand strategy among many providers has been to implement necessary technologies such as electronic medical records. Clinical decision support tools in particular have been an important aspect of the value-based care strategy since these technologies boost advanced imaging protocols.

Ryan Lee, MD, MBA, Director of MRI, Director of Quality and Section Chief of Neuroradiology at Einstein Healthcare Network, told HealthPayerIntelligence.com about the key ways that providers could use clinical decision support tools to bolster value-based care reimbursement.

“I think clinical decision support is that much more important in the value-based model because it eliminates waste. In the value-based model, waste is of high importance to eliminate. Clinical decision support allows a clinician to order the right test at the right time to minimize the wrong tests being ordered, and potentially even unnecessary tests,” Lee said.

“I don’t think clinical decision support is leading us down the path of the value-based model. I think that path is already being steered toward the way legislation is being written, but it does help eliminate waste,” concluded Lee.

It is also important to include mobile health tools when considering adopting value-based care reimbursement models such as running an accountable care organization or creating a bundled payment structure. Goshen Medical Center from North Carolina is one example of a facility that’s using mobile health tools to better manage chronic illnesses.

With a majority of the patients serviced at Goshen Medical Center on Medicare, it grows important for the facility to align with the alternative payment models expected from the Centers for Medicare & Medicaid Services (CMS). Using a mobile health platform and remote monitoring allows the medical facility to better track their patients.

“With the (healthcare) industry moving toward managed care and targeted interventions, we have to learn how to monitor our patients … and provide frequent ‘touches’ that give them value and help (providers) identify problems and issues that they might not see during an annual visit,” Greg Bounds, CEO of Goshen Medical Center, told mHealthIntelligence.com.

Incorporate population health management

Population health data is vital in the pursuit of value-based care reimbursement. With more providers focusing on prevention and wellness visits as well as reducing hospital readmission rates, population health data analysis remains a key strategy for improving the quality of care and achieving the benchmarks seen in many value-based care payment structures.

When creating an accountable care organization, incorporating population health management will be essential when striving toward meeting the benchmarks of the Medicare Shared Savings Program.

The Academy Huron Institute also supported the idea of strengthening the use of population health management in value-based care initiatives as more providers and payers transition to alternative payment models.

Bring risk into value-based care reimbursement contracts

A final key strategy that payers and providers must incorporate when attempting to function in a value-based care environment is a contract centered around risk. IDC Health Insights released a report this past June outlining how value-based care reimbursement models can incorporate shared risk and capitation full risk protocols. IDC Health Insight’s Jeff Rivkin discussed in an interview with HealthPayerIntelligence.com about the role risk plays in a value-based care payment strategy.

“A portion of the provider's total potential payment is tied to the provider's performance on cost efficiency and quality performance measures. While providers may still be paid a fee for service for a portion of their payments, they may also be paid a bonus or have payments withheld. For value-based contracts, this bonus is not paid unless the providers meet cost efficiency and/or quality targets,” Rivkin discussed how risk is used in value-based care.

“Clinical integration fees paid to providers are contingent on the providers engaging in practice transformation to adopt technology and processes that alter the manner in which they deliver care. Provider goals include accountability to their patients, creation of advanced care teams to include nurse care managers and pharmacists, and implementation of automated processes to address prevention and wellness,” concluded Rivkin.

Healthcare payers and providers are advised to follow these three key strategies when creating value-based care contracts and implementing alternative payment models as they transition away from fee-for-service payment structures.

 

Dig Deeper:

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