How To Make Value-Based Care More Profitable?

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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
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How To Make Value-Based Care More Profitable?

• 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

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How To Make Value-Based Care More Profitable?

• 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 providers 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.

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How To Make Value-Based Care More Profitable?
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.