How Can Your Organization Prepare for Value-Based Payment?
- Gabriella Biondo, MPH
- Sep 21, 2017
- 2 min read
We all know it is coming… MACRA/MIPS has sealed the deal and providers are going to be paid based on value. CMS isn’t the only trend-setter, more commercial payers are jumping aboard the value train. Patient Centered Medical Home programs, Medicare Advantage plans, and quality incentives are becoming a larger percentage of organization’s revenue.
Organizations need to intentionally prepare. Where can they start?
Step ONE: Centralized Reporting We have been tracking data in the fee-for-service model but now we will be required to take our data collection and reporting to a new level. Data needs to be timely, readable, and actionable. We need to capture quality measures via data input into the EMR on a timely (and ideally instantaneous) basis. Actionable dashboards with views unique to each role for the front desk staff through to the CFO are essential.
Step TWO: Coordinated Technology Most of us are utilizing EMRs and we rely heavily on them as the foundation for all technology needs. Does your EMR allow for shared care plan development across specialties, community health organizations, and provider groups? Does it track referrals and confirm patient appointments at both internal and external providers? Being prepared for value means wrapping your organizational arms all the way around your patients and engaging with technology that can facilitate the care coordination process.
Step THREE: Efficient Care Management Care management comes in many shapes and sizes. What’s important to instill in your organization’s culture is the value of patient education. The patient can be his or her own most valuable advocate. Care management teams that focus on patient education, bring patients to the table to discuss their heath and health outcomes, see better outcomes.
Step FOUR: Coding Documentation Improvement Many if not all of the value-based payment models that we see in the marketplace use a patient risk calculation based on diagnosis codes submitted via claims in their payment calculation algorithm. This means that it is now of utmost importance that providers document completely, accurately, and with the highest level of specificity. Regular coding audits and education are critical for success.
Step FIVE: Effective Physician Contracting Aligning incentives is part of helping your providers understand how the value-based payment models will impact their clinical work. If what is expected of them changes without impacting their compensation model, buy in will be difficult to obtain. Physician contracts should align incentives with financial, compliance, and operational goals.
Are you prepared? Contact us if you need assistance with any of these steps.
graph source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html