Value-Based Care: Delivering More Using Less

The idea of delivering more using less seems like the same turnip we have all tried to squeeze countless times before. With the emerging addition of Value-Based Care (VBC) reimbursement models, now the struggle to keep pace in a mixed-mode, straddling everything from Fee-for-Service to Full Risk Sharing contracts, is real. While payers are becoming more transparent in sharing risk-based patient population data with providers, the lack of VBC contract performance standards across plans and mountains of cost, utilization, gap, and stars data can make the idea of efficiently managing such arrangements seem about as possible as winning the next mega lottery jackpot.

In recent travels, I have seen first-hand how arduous the process can be. The adventure begins with the fact that payer provided data is stale, refreshing in PDF format – Excel if you are lucky – once a month. From here, data must be further scrubbed to determine if gaps identified by the payer are actually real: is the claim still in progress, was a code missed when billing, or perhaps results came in since the report refreshed. Gaps in error are then closed in the corresponding payer’s online portal or worse, a dreaded paper dispute form. And now, days to weeks later, the data is ready to be acted on at the patient level by the site’s care team.

The bottom line is the healthcare system, as it is today, is not sustainable. But the good news is that opportunity to transform exists using better, cleaner data…

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Collaborating in Community Healthcare

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Ortho Rhode Island chose Centricity™ Practice Solution

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Innovation in Perinatal Nursing

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