Understanding the Shift to Pay for Performance and Value-Based Care
Over the last 15 years, we have seen healthcare models transition from fee-for-service to value-based care (VBC) and pay for performance as the US federal government works to drive down our nation’s high healthcare costs and promote better outcomes for those you serve. These types of reimbursement models focus on the value of care that clients receive with measurements deriving from the healthcare outcomes rather than the number of services provided like in fee-for-service or a capitated approach. These reimbursement models look to hold providers more accountable for improving their clients’ health outcomes and to help lower healthcare costs. The shift to VBC and pay for performance contracting has gained traction in many healthcare specialties, including Intellectual and Developmental Disabilities (IDD).
Embracing Pay for Performance and Value-Based Care for IDD
This shift towards value-based care and pay for performance models should improve care and support better outcomes for IDD clients. By aligning your pay for performance and VBC strategies with the right technology, IDD providers can survive the shift and even thrive in the new market while ensuring their community receives the best care.
By focusing more on positive care outcomes, these new models can shift provider attention towards the most effective treatments in terms of cost and client impact. This is especially important for IDD populations who require ongoing, specialized care that connects medical, behavioral, and social support services. VBC and pay for performance models ensure providers can deliver the necessary care to these individuals without feeling limited by billing practices.
Strategies for a Seamless Transition:
Optimizing Data Collection and Reporting
As pay for performance and value-based care become more and more a market reality, it’s important to understand how your organization is going to pivot towards these models.
Data collection is much more important and complex in pay for performance and VBC, and you need to identify the specific metrics that are most relevant to IDD care. This might include quality-of-life data like personal choice, self-advocacy, self-determination, and community inclusion. Taking note of how much the individual interacts with the community around them as well as how they feel they’re being treated can be just as impactful as their physical health and safety.
Documenting all medications, including errors, is also important for reporting. Using the right electronic health record system (EHR) can significantly affect clinical care and documentation. Qualifacts has a platform of EHR solutions designed specifically for IDD care that makes prescription processes easy and convenient for providers.
Work with your team and use relevant research to pinpoint how your organization will measure the results of the specific care you provide. Having an internal standard is going to help your staff better understand how they need to adjust their notation and reporting. Provide these measurement policies to your staff so everyone is on the same page with documentation expectations.
Harnessing Data Insights for Improved Outcomes
After your IDD population data tracking is set up, your providers can use that data to better inform care decisions. You can look at trends and how similar care plans have impacted outcomes in other individuals. This analysis will enable you to better understand what kind of care might benefit a particular individual.
Your population data is valuable for reporting and for your providers. This is where you need specific technology solutions that can generate reports and provide actionable analytics and insights. More data enables your providers to create better treatment plans that unlock better outcomes for those you serve. You can take a comprehensive look at how individuals are responding to their care plans, which providers are behind in their documentation, and your general business analytics. All of this can help you improve various aspects of your organization. You can improve performance across your organization by looking at provider documentation metrics, population health data and the financial health of your agency.
Ensuring Financial Stability
It’s important to address the financial aspects of these new reimbursement models. Work with your finance team to understand what risks your organization may face during this shift and develop risk mitigation strategies to help in case of potential revenue shortfalls.
Advanced EHR services can be a major boost for your organization by optimizing documentation and reporting. These solutions also provide claims approval data insights, which will help you understand how your organization is doing with the shift in reimbursement. These EHR-facilitated insights will help you identify shortfalls, where to focus your attention, how to prevent errors, ways to reduce denied claims, and other performance issues.
IDD providers that use EHR integrated data analytics can deliver high-quality care to their communities while ensuring long-term financial stability.
The Role of Qualifacts EHRs in Pay for Performance and Value-Based Care
As more states require VBC and pay for performance contracting, having an EHR built for these reimbursement models makes the switch much easier. The Qualifacts platform makes it easy to capture all the required data and metrics needed for claims submissions, taking pressure off your staff. Our automated coding, modifiers, claims scrubbing, batch processing, and customizable reporting tools reduce denied claims and appeals, increasing overall revenue. This automation eases the workload on your staff, helping reduce burnout and turnover while giving them more time to focus on the communities they serve.
The Qualifacts team continually monitors all federal, state, and local requirements surrounding reimbursement models, so you can confidently adapt to regulatory changes while prioritizing client care.
