Guest post by Richard A. Royer, MBA, chief executive officer, Primaris.
It has been several years since Medicare began introducing payment changes aimed at driving the healthcare industry away from volume-based payments and toward value-based reimbursements. One of the main purposes of the payment system’s overhaul is to improve the quality of care that healthcare providers deliver to patients. Of course, the other main goal is to keep costs in check. In simple terms, the shift to value-based incentives rewards providers that deliver on cost, quality and patient outcome measures. What many providers have learned along the way is that technology plays an important role in the transition to value-based care, and meaningful use of electronic health records is necessary for success under value-based incentive programs.
Value-Based Payment Basics
For healthcare providers that are working to adapt to new payment models and are just beginning to make adjustments, understanding the basics of value-based care is the first step to success. Some of the key points healthcare providers need to recognize about value-based reimbursements are:
- The value model rewards performance. That can mean a number of different things, for example, achieving high quality and patient satisfaction scores or making improvements to care over time. The point is, providers must focus on meeting certain standards for care and cost in order to be eligible to earn financial incentives and to avoid penalties.
- Value-based care models are extremely data driven. Providers need to measure and report performance outcomes in order to assess their efforts internally, and also so they can earn reimbursements from external payers. As a result, healthcare providers need to continuously measure and analyze patient data, not just collect it.
- Collaboration is an important success factor under value. Patients – particularly those with chronic health conditions – receive care from multiple providers as they move across the care continuum. To ensure that treatments, medications, and care plans are safe and effective, and that patient outcomes (which impact reimbursements) are the best they can be, providers need to communicate with each other and work to coordinate care. Value-based programs demand coordinated care.