Value-Based Care & Patient Engagement Programs
Fee-for-service has been the predominant health care payment model in U.S. Value-based care models are aimed at improving, redesigning, or replacing the fee-for-service methodology. This strategy aligns with CMS initiative to move to value-based payments, where rewards are paid based on achieving health outcomes. As per CMS, agency met its goal to tie 30% of reimbursements to alternative payment models by the end of 2016 nearly one year ahead of schedule—up from 20% in 2014 and hopes to increase this percentage to 50% by the close of 2018.
In value-based contract with a payer organization, physicians/medical groups agree to be measured on quality, cost and utilization measures related to health care outcomes. Based on compliance with or attainment of the identified quality and performance measures, the provider receives positive adjustment (as an incentive for performing to the desired outcomes) or negative adjustment (a penalty for not achieving those health outcomes).
In order to achieve these metrics, systems must be in place to continually monitor quality, target areas for improvement, and employ best practices for quality improvement, utilization management and care management on an ongoing basis. In addition, because reimbursement is tied to outcomes, a structured process of monitoring reimbursement, including following best practices for contracting and managing risk must be done.
Through Practice transformation, our team provides practice consults on pre-visit planning and closure of gaps in care, develop and implement initiatives to improve performance against value-based contract goals, guide practices in individual planning efforts tailored for each practice, coding & documentation education and optimization of practice workflow redesign.
The final supporting element for value-based care is patient engagement. High quality outcomes for the patient need patients understanding of their role in health maintenance and preventive care. Our care management and health coaching team provide targeted care management and self-management support for high-risk, high-need patients, as well as rising-risk patients. The care team partners with patients so that patients are actively engaged in understanding of their diagnosis, set individual goals and care plans and actively pursue healthier outcomes.