Value-based care is the intersection of cost and quality. Value-based initiatives shift the care delivery focus from volume to value and redefine financial incentives toward reduced costs. In this model, physicians must think about the entire patient experience among all care settings and between episodic visits.
From a cost perspective, the total cost of care encompasses all spending for the patient—and the patient population as a whole—grouped, benchmarked and analyzed by condition. As the provider mindset shifts to address this model, taking the appropriate steps in terms of patient engagement, technology and workflow are the key first steps to value-based success.
Organizing care teams of clinical and non-clinical staff under a value-based delivery sets a solid foundation for a value-based setting. Teams track patients throughout their care cycle, and establish a tailored process for patient outreach and engagement. By considering the patient’s experience beyond the office, care teams can take a longitudinal approach to care delivery to meet value-based care delivery targets.
Managing the overall health and care delivery for a patient population requires an effective technology solution to effectively collect, aggregate, and analyze patient data. In addition to aiding in predictive modeling and implementing evidence-based care plans, collecting clean, quality data helps strengthens your reporting to ensure you receive appropriate payments and incentives—while avoiding costly penalties.
Establishing effective clinical workflows—both at the micro and macro levels—ensures clear lines of responsibility, establishes best practices for effectively collecting and reporting on required data, and understanding the comprehensive care requirements for patients and patient populations.
As your value-based capabilities mature, the next step in growth is to evaluate which clinically relevant private or public payer reimbursement models to pursue, be it a PCMH, ACO or horizon programs being finalized for the rollout of the Medicare Access and CHIPS Reauthorization Act of 2015 (MACRA).
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