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Transitioning to Value-Based Care: Meet the Challenges With Better Technology

Posted by Sue Ellen McKelvey on May 4, 2017

shutterstock_538667197.jpgA value based healthcare model strives to improve the quality of the care delivered and demonstrate better client/patient centered health outcomes whilst also lowering healthcare costs. This has the potential to benefit both the providers and healthcare consumers they serve. However, it also represents an entirely new business model for a clinic and their clients as well as the provider team. A new base for payments is the challenging reality in the stressed healthcare system of developed countries. This new approach requires a big shift; transitioning from the traditional fee-for-service system has some challenges. Here, we hope to talk to these transitions and detail some of the key challenges providers are facing as they make that transition. The role of your healthcare IT platform is important; it should in 2017/2018 be an asset and a friend of the clinic in helping to show value based care for clients as well as helping the provider team to meet performance challenges.

The Challenges of Managing Value-Based Payments in A Fee-For-Service Industry

While value-based healthcare payment models are on the rise, the overall healthcare system is still structured around the traditional fee-for-service model. everyone is paid on the number of items/inputs not the outcomes. A transition is happening; we need to work within the existing system, with payers continuing to reimburse healthcare providers on a fee-for-service basis throughout the year, then calculating bonuses and/or penalties for providers at year end. This is how the transition will continue - many newer payment models are being structured - your IT platform is to be maximized to work with what your model of value based care is and its data collected to easily comply with the requirements of value base reporting.

This need to create reports for a system based on value based care payments can be a challenges for clinics and healthcare providers; already busy and time poor; clinical flow of client/patient feedback and outcomes tracking can be a business management and staffing challenge. Clinics and clinicians suddenly have other areas to be recorded as well as the standard processes. And some areas of work for these reports are better done during the year, not waiting till the year-end to assess the value base of the care delivered. Client/Patient feedback and satisfaction as well as client direct input as to their improved health outcomes must be tracked during the year for the year end report. It is important to be actively learning as to how an area of 'performance' measures up under these new payment models. The ultimate reimbursement levels may depend on staying aware throughout the year, making it possible to change course as necessary to meet financial and/or quality performance benchmarks. This means that providers must continually track their own performance in order to accurately anticipate the results of year-end reconciliations, which makes more detailed and sophisticated accounting and data management practices necessary.

Costs must be precisely tracked for each patient served under value-based healthcare payment agreements. Costs are compared to financial performance benchmarks to ensure that performance goals are met. Quality measures must also be tracked precisely to ensure the clinic and clinicians meet or exceed benchmarks. Further complicating things is the fact that those goals typically vary between differing payment models, as well as from one specified patient population to another under the same payment models. Additionally, under bundled payment arrangements, providers must make themselves accountable for tracking cost and quality data of each healthcare consumer across the entire continuum of care; keeping track of factors - whether primary care responsibility rests with other healthcare providers along that care continuum they are able to produce a report as to the value base of the care provided.

How Better Healthcare Information Technology Can Help

Many Healthcare IT systems in use today simply are not equipped to handle these new data-intensive demands. And most Healthcare IT systems were designed for the traditional fee-for-service healthcare model or for a series of inputs around the processes of billing. Many of them are poorly integrated to accommodate the new level of data required across , made up of diverse software solutions that do not always play nicely with one another, making it more difficult than it should be to pull all relevant data together for the accurate tracking/analysis needed today.

To achieve the level of comprehensive, in-depth data collection, tracking and analysis it takes a comprehensive, single-platform system built specifically for this new approach within the current healthcare system. It must be designed to accommodate a full range of payment models and practice styles, provide efficient end-to-end software solutions for all medical and non-medical practice needs, and seamlessly connect providers, healthcare consumers and payers. Finally, data is ideally collected by a single database, across all these areas, creating the capability for instant access to and analysis of data from all sources.

A system with these advanced capabilities is essential infrastructure in today's healthcare market, providing the flexibility and functionality providers need to meet the challenges they face today in transitioning to value-based care -- as well as whatever comes next in the continuing evolution of the healthcare industry.


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Topics: value-based healthcare

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