Serving the Value-Based Care Community | |
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MedCity News | May 27, 2024
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Before the pandemic, hospitals in the U.S. were making notable progress in the effort to address flagging patient safety and care quality metrics. And that effort paid off — adverse events and safety and quality issues plummeted in the decade before Covid-19.
But the latest numbers available demonstrated a reversal in that trend, as hospitals and healthcare systems facing unprecedented labor gaps, falling reimbursement rates, and patient leakage found themselves unable to maintain momentum in the fight for better safety and quality.
And although the pandemic may have been one catalyst for declining quality and safety, driving these trends are systemic issues that have plagued healthcare for decades.
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To provider organizations, the Change Healthcare hack in February was a painful reminder of a lesson learned during the first year of the COVID-19 pandemic: A disruption in revenue flow can lead to financial disaster or even closure. Many smaller hospitals and medical offices have struggled to get paid since the ransomware attack shut down Change’s billing and payment system. Similarly, provider organizations that relied heavily or even solely on fee-for-service (FFS) in 2020, but, as a result of the COVID pandemic, could not treat patients and, therefore, not get paid. Clearly, FFS has its flaws, which have given rise to alternative payment models such as value-based care (VBC), along with efforts by CMS to promote accountable care organizations (ACOs) that prioritize patient outcomes and cost controls over volume of service. | |  |
At first glance, CMS’s recently released 2022 QPP Experience Report (PDF) seems reassuring, because the majority of clinicians avoided financial penalties under MIPS. Don’t be fooled! While overall success and failure rates in the report may lead you to conclude that merely participating in the QPP (either in MIPS or as an APM) is enough to do well, trends in the report tell a very different story: Without a concerted and cohesive strategy to simultaneously improve efficiency and demonstrably improve quality, providers will begin to see their consistent results fall short of minimum performance thresholds. The QPP Experience Report details participation in the MIPS and APM tracks of the Quality Payment Program (QPP). Performance results focus on MIPS, from both the Traditional MIPS participation and MIPS APM tracks. (MSSP ACO performance results are released separately.) | | |
Though the Trusted Exchange Framework and Common Agreement (TEFCA), is a relatively new development in healthcare, it has major implications for every healthcare organization and its patients. In short, TEFCA outlines the terms and conditions that will allow for the exchange of electronic health information (EHI) across different Health Information Networks (HINs). This will make it possible for providers, risk adjusters, and payers to access patients’ health information when and where they need it. We believe TEFCA is a powerful mechanism for increasing efficiency, driving down costs, and improving patient outcomes. While not the end-all-be-all solution, it’s a vital step in the right direction toward national interoperability. In this article, we’ll provide a high-level overview of what TEFCA is and why it matters for value-based care organizations. | | |
The answer is ‘yes’ from a paper by Lin et al. (2024). Using 2009-2013 data from the Massachusetts All-Payer Claims Database, the authors measured physician–hospital integration within an accountable care organization (ACO) based on the proportion of primary care physicians (PCPs) in an ACO who billed for outpatient services with a place-of-service code indicating that there were employed by a hospital or the practice was owned by a hospital. The mapping of Massachusetts physicians and hospitals to ACOs came from the Massachusetts Registration of Provider Organizations (MA-PRO) data. Patients who seek care at more integrated ACOs may differ from those who prefer less integrated ACOs. | | |
Upcoming Sponsored Webinars | |
VBCExhibitHall offers FREE educational webinars for those who are working in value-based care (VBC), or would like to learn more about VBC! We encourage people to attend the live webinars so as to have the opportunity to participate in the Q&A. However, if you are unable to attend, a link to the recorded webinar is sent to all who sign up. Please register using an accurate email address so that you can receive the link to join and to the recording. | | |
How the CMS National Quality Strategy Can Guide You on Your Value-Based Care Journey, Part One | |
CMS National Quality Strategy and the CMS Innovation Center, and the ways in which they can provide the foundation of your plan
(Part One of Three: Value-Based Primary Care Means More than Measuring Total Cost of Care)
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Beyond GUIDE: How data-driven strategies are paving the path for better dementia care | A case study of how data-informed approaches are being used within dementia care to identify critical areas of need, address underdiagnosis, promote health equity, and improve patient outcomes | | | |
Overcoming Population Health Pitfalls: 5 Proven Strategies for Value-based Care Orchestration |
Population health pitfalls and how leaders can make data-driven program decision to avoid them and manage total cost of care | | |
How the CMS National Quality Strategy Can Guide You on Your Value-Based Care Journey, Part Two | |
CMS National Quality Strategy and the CMS Innovation Center, and the ways in which they can provide the foundation of your plan
(Part Two of Three: Using Innovation Center Models to Drive Efficient Specialty Care)
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Interoperability & TEFCA: The Road that Got Us Here, Where We Are Now, What's Next |
The pivotal journey of interoperability in healthcare, exploring the significance of the Trusted Exchange Framework and Common Agreement (TEFCA), current data insights, and future directions | | |
How the CMS National Quality Strategy Can Guide You on Your Value-Based Care Journey, Part Three | |
CMS National Quality Strategy and the CMS Innovation Center, and the ways in which they can provide the foundation of your plan
(Part Three of Three: Maintaining Your Competitive Edge: How to Avoid Stagnation)
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Check out our Webinar Archive to view past webinars on a variety of value-based care related topics! | | | |
Virtual Fifth National Medicare Advantage Summit | July 9 - 12, 2024 | Virtual | | | |
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On occasion, we showcase one of our solution providers in a 4-5 minute interview and ask them what they bring to the VBC Community and what sets them apart.
Today's guest:
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CareJourney is a leading source of provider cost and quality analytics for the healthcare industry. They support payers, value-based networks and numerous ACOs, helping them assess value-based care models, optimize provider performance, coordinate patient care and uncover market growth opportunities. CareJourney does this by consolidating and enriching Medicare FFS, Medicare Advantage and Medicare and Commercial claims data for more than 275M lives to produce over 300 key provider performance indicators for more 2M+ Physicians. | | | |
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Platinum Level Exhibitors
Thank you to our Platinum Level exhibitors! These organizations offer the absolute highest quality products & services to the value-based care community. To learn more & visit their interactive booths, click on the logos below:
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Gold Level Exhibitors
Thank you to our Gold Level exhibitors! To learn more & visit their interactive booths, click on the logos below:
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Find out how your organization can be featured here and receive additional benefits including a customized booth on our website, social media campaigns, hosted and marketed webinars, an interactive session with top-level VBC executives and consultants, and more! Click here! | | | | |
