Proving Value in the World of Value-Based Care

Melissa Blackman

As the federal government and major insurers turn to performance-based payments to improve healthcare quality and lower costs, physician groups across the nation are struggling to adapt.

These value-based care models require lots of data to be collected and reported back. Many practice groups are trying to keep up manually with scads of Excel spreadsheets. It’s a major headache and they’re ready for a better way.

My Texas-based client is one of them. The 420-physician network of cancer specialists is one of nearly 200 practices participating in the Oncology Care Model (OCM). OCM was developed by the Centers for Medicare & Medicaid Services (CMS) to provide better, more coordinated care to Medicare cancer patients. If a practice group provides quality care while reducing the cost, Medicare will share the savings via bonus payments. At stake for my client is up to $15 million in bonuses over the five-year OCM project.

Automating data tracking can save practice time, improve accuracy, and make sure they get paid. That’s where I come in!

Good-bye to Spreadsheets
As a workflow optimization consultant with GE Healthcare, I help clients capture the needed data from patient scheduling and billing systems, report it as required, and optimize workflows to automate billing.

For the OCM project, we are setting up the Texas physicians to track:
• Participating patients (only those getting chemotherapy and certain other treatments are eligible)
• The start and end of each six-month episode, starting with the first chemotherapy treatment
• Patient wait times (tightly tied to patient satisfaction scores)
• Payments for services plus an additional monthly payment per OCM patient

Automating Payments
Reimbursement for patient care in the OCM project is handled differently from standard Medicare. To allow our client to automate billing, we’re setting up OCM as a separate payer.

In addition to normal reimbursements, OCM pays an extra $160 per month for each participating patient to cover the costs of managing and coordinating care. If the extra payment isn’t received, the patient account will be flagged. We do all we can to make sure our clients get paid!

Helping Patients Navigate the System
One of OCM’s goals is to help patients navigate the sometimes-bewildering healthcare system. We’re setting up “appointment sets” that package together all the needed touch points – from financial counselor to chemo treatment to lab blood draw to doctor visit. It’s very structured so each patient knows when and where to go.

The appointment sets we create will let the office staff check-in the patient for all sessions when they arrive. Each department moves the patient from bucket-to-bucket to track how long the patient spends in each department and their wait times between sessions.

It’s all part of taking a more wholistic approach to healthcare ̶ not parsing care out piecemeal.

How are you handling the data requirements of Value-Based Care payment systems? Post a comment and let us know how it’s going.

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