Understanding the Shift to Value-Based Care

Over the last 15 years, we have seen healthcare models transition from fee for service to value-based care as the US federal government works to try and drive down our nation’s high healthcare costs and to promote better outcomes for those you serve. This type of reimbursement model focuses on the value of care that clients receive with measurements deriving from the healthcare outcomes rather than the amount of services provided like in fee-for-service or a capacitated approach. Value-based care (VBC) looks to hold providers more accountable for improving their clients’ health outcomes and looks to help lower healthcare costs. This reimbursement model continues to gain traction in many medical specialties, including Intellectual and Developmental Disabilities (IDD).

Embracing Value-Based Care for IDD

This shift towards more value-based care models is a positive step in the direction of better care and better outcomes for IDD clients. By implementing the right strategy and the right technology, IDD providers can not only survive the shift, but they can learn to thrive in the new market while ensuring the individuals they serve receive the best possible care.

By focusing more on the quality of care rather than just the type of care, VBC can help shift focus away from offering clients the most expensive treatments a provider can bill for to care that will have a greater impact for that client specifically. This is especially important for the IDD population who aren’t simply visiting a provider for checkups or an injury but instead require ongoing, specialized care that encompasses medical, behavioral, and social support services. Value-based care ensures providers are able to deliver the necessary care to these individuals without feeling limited by billing practices.

Strategies for a Seamless Transition:

Optimizing Data Collection and Reporting

As value-based care is likely here to stay due to political and competitive pressure on payers, employers, the federal government, health plan costs, and more, it’s important to figure out now how your organization is going to tackle the switch after deciding that it’s time.

With data collection being one of the primary factors in value-based care, you need to identify the specific metrics that are most relevant to IDD care. This might include focusing more on the individual’s quality of life such as 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 by those around them can be just as impactful as their physical health and safety.

Documenting any and all medications, including any errors, is also very important for reporting. Using the right kind of electronic health record system (EHR) can significantly help keep track of prescriptions, drug interactions, and medication errors. An EHR like those designed by Qualifacts makes keeping track of all prescriptions easy and convenient for providers and helps prevent drug interactions and errors.

Work with your team and use relevant research to pinpoint how exactly your organization is going to measure the specific kind of care you offer, keeping it client centered with eyes on progress. Having an internal standard is going to help your staff better understand how they need to adjust their notation and reporting. Write down these measurement policies somewhere easily accessible to help keep everyone on the same page with how to write their documentation.

Harnessing Data Insights for Improved Outcomes

Once you start to track relevant data for your IDD population, you will be able to use that data to better inform medical decisions. You can look at trends and how similar care plans have either benefited or stagnated growth in other individuals, allowing you to better understand what kind of care might work better for a particular individual.

The data you can generate based on the population you serve is valuable for your providers, not just for reporting. The right technology can allow you to create easy-to-understand reports and charts based on your organization’s data input, offering powerful analytics and insights for your team. More data means more information for creating better treatment and care plans that should lead to improved 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.

Ensuring Financial Stability

While the shift to value-based care is important for offering better care and improved outcomes for your IDD population, it’s equally important to address the financial aspects of such a transition. 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.

Leveraging advanced EHR services can be a major boost to your organization by streamlining documentation and all reporting. It can also provide data insights to your claim approval rates which will significantly help you understand how your organization is doing with the shift in reimbursement model. With such tools, you will quickly know where any shortfalls are coming and where to focus your attention, preventing errors, denied claims, and other issues from piling up unnoticed.

By focusing on building accurate and meaningful data collection alongside financial preparedness with a commitment to quality, IDD providers can not only adapt to this changing healthcare landscape but can achieve financial stability while delivering high-quality care to those they serve.

The Role of Qualifacts EHRs in Value-Based Care

Qualifacts makes it easy for offices to comply with all reporting requirements for VBC and is well-equipped to handle the differing requirements other state governments might require. The right EHR can be the biggest help in transitioning to a new reimbursement model, especially for your providers who already have a lot on their plate every day. By having a system that makes it easy to capture all the data and metrics needed to submit with claims, staff won’t be leaving out crucial information, and you can rest assured that it will be sent to the right place in a timely manner in the format that is required for seamless processing.

Our team is constantly monitoring all requirements and regulations surrounding various reimbursement models, so you can be confident that we will update our technology to comply with any future regulatory changes.

If you’re interested in learning more about how Qualifacts can help your IDD make the transition easier for your organization, click here to learn more.