The Shift to Value-Based Pay in Healthcare

CMS has declared they are attempting to tie 50% of their reimbursements to value-based care by 2018, and 30% by next year (2016). This marks an impending concrete shift to value-based care over fee-for-service for all Medicare participating providers. Providers will need to change their systems and strategies to stay in the field, but even with the correct changes the revenue stream may take a hit. Though there are a few steps that will coordinate the new clinical processes and revenue operations with healthcare organizations, adjusting their strategies to value-based care.

Any Medicare-participant organization will need to provide their patients with access to preventative care measures, and not only in referrals but in their own practice. These providers will need to house enough competent staff to deliver preventative care, and chronic care treatment to patients. The value-based payment model has a large emphasis on preventative care; as CMS sees this as the caring for the whole population of patients and keeping them healthy so as to not incur more healthcare costs.

Healthcare institutions will have to offer their physicians financial incentive to provide the best value-based care so as to reach the goals of the institutions, specifically in participation of shared savings. This will be a huge change for the physicians who have previously acted on the fee-for-service model, with volume as its goal. Furthermore, this will also be a large shift for the healthcare institutions who will have to financially incentivize their physicians based on the value metrics. “These could include readmission rates, clinical quality, efficiency, use of EHRs, and patient satisfaction…”

ThinkstockPhotos-89676476This healthcare shift also calls for a closer partnership between the provider and the payer. This is due to the transition phase for the provider to ensure proper benchmarks and standards with the payer; as the payer holds the final decision on the reimbursement standard.

This value-based care relies heavily on analytics, specifically on population data as opposed to patient data. Not necessarily predictive analytics, but instant data analysis of your patient population. It is expected that the healthcare institutions will use this pervasive data analysis system to make the right and informed choices to save costs and provide better healthcare. This is the type of system that Salient Management Company offers, and it has already made great strides in yielding providers with cost-saving value-increasing data.

Lastly, all your technology systems must work together and integrate with each other to provide the best result for your organization. The systems must be able to share data, and must automate end-to-end processes to increase efficiency and reduce costs. This is yet another huge success that Salient Management Company’s software has been able to achieve for healthcare providers.

Source via Healthcare Finance.

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