Article - How to Make Value-Based Care More Profitable?

Value-based care (VBC) models incentives providers to deliver best-in-class services on three fronts such as improving patient care experience, improving the health of populations, and reducing per capita cost. According to a research study, 75 % of ACOs in its Population Health Management Collaborative achieved savings of more than $700 million to their organizations.

Apart from cost saving, the main direct benefit of value-based care compared with Fee for service (FFS) is that the scarce resources can be directed to patients who need care the most, and the health of at-risk populations can improve.

As discussed above, value-based care incentivizes providers to be cost and quality-conscious by offering performance-based bonuses. While being quality conscious you need to understand quality measures which include structural, process, and outcome. However, quality is difficult to measure due to various challenges such as political, technical, individual vs. group measurement, and measure specification variation between programs.

In the following brief, you can have a brief overview of each challenge mentioned above:

Political challenges:

  • Physician stakeholders careful about ultimate data usage
  • Absence of consensus about what measures are appropriate
  • Inability to secure consistent access to data

Technical challenges

  • Creating measures that satisfy codified data requirements not aligned with real-world clinical workflow
  • Absence of comprehensive data sources and non-standardized information systems

Individual vs. group measurement challenges

  • Quality measures are often written to evaluate the performance of an individual physician for a full calendar year, not a group
  • Specifications do not always easily scale/translate to evaluate groups or to evaluate smaller time frames

Measure specification variation between programs challenges

  • The difference in format for specification documentation
  • Requirements for Codified data set vs. narrative guidelines

Apart from all these challenges you can make Value-Based Care More Profitable with the following strategies.

Value-based care strategies:

Look for a long-term financial goal

First of all, you need to identify the long-term financial opportunity and need to take into consideration of the anticipated decrease in utilization and infrastructure needs along with the projected increases in margin derived from value-based payment performance success to reach your long-term financial goal.

Identify population and payer

You need to build a financial modeling exercise which includes all the provider’s current value-based and fee-for-service performance, populations, and health plan market dynamics. With the help of this, you can create transparency around the impact of value-based payment across the entire payer mix and enable the development of the payer strategy that produces the best value-based payment and contribution margin results.

Identify and plan the metrics for success

Most metrics include various factors such as accurate risk scores, quality metric performance, and clinical and social interventions. These metrics are needed to successfully manage patients across the period of care. But you need to stratify these metrics by priority over a timeline.

For example: Risk scores are key to calculating a benchmark or capitation rates that reflect the acuity of the population being managed and therefore are critical to establishing the right global value-based payment budget.

These budgets can help to model and track financial performance along with margin impact. Therefore, before the execution of clinical interventions, providers may prioritize the calculation of these metrics.

Look for analytics capabilities and actionable intelligence

You need to check the effectiveness of your care strategies as well as course correction if needed with the help of analytics capabilities and actionable intelligence. Periodic reporting ensures both the transition is on track and the organization is on pace to reach the stated financial goal.

Finally, you need to leverage EHRs to drive down costs by implementing EHRs in both hospital and ambulatory settings and create the best possible outcomes for the patient. If you are looking to outsource your medical billing, then you can get in touch with us.

Published By - Medical Billers and Coders
Published Date - Jun-24-2021 Back

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