Serving the Value-Based Care Community |
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HealthPayerIntelligence | June 20, 2023
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Payers should consider program design intensity when implementing value-based purchasing contracts, as higher-intensity programs can lead to better care quality and greater spending reductions, a systematic review published in Health Affairs found. Value-based purchasing programs can incorporate both financial and non-financial features. Financial aspects include bonuses, penalties, and financial risk-sharing arrangements. Non-financial aspects aim to help providers respond to the spending and quality incentives in a VBP program. These include analyzed data, reports, or lists; technical assistance through leadership or change management training, infrastructure payments to add more staff; raw claims data; risk-management support; and care management support.
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As a concept, everyone believes that a patient should be at the center of care, supported by shared decision-making. Patients and their clinicians review the best available evidence, review the options, look at costs and benefits, and together decide how to proceed. In reality, in a shift from fee for service to bundled health care payments that are now expanding to include oncology services, how will those processes play out in the years to come, given the inherent existential nature of issues raised by having advanced cancer, even as treatments continue to advance for some metastatic disease? And will difficult, emotional conversations about when to move from curative cancer therapy goals to palliative therapy or even hospice care become even more fraught when the specter of capitated fees is lingering in the background? With drug costs for cancer now surpassing any other disease state, could physicians be incentivized to discontinue futile care—and who defines futile care? |
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Most people need some level of healthcare at the end of life. In fact, 25% of all Medicare spending occurs during patients’ last years, and research shows roughly 70% of adults prefer less aggressive treatments during their final days. Still, few people have frank discussions about the medical services they’d like to receive before the time comes—only 17% of patients say they’ve talked about it with their doctor. Consequently, many individuals receive costly services they’d rather avoid. Advance care planning can help patients sidestep this problem. Through this process, patients can clearly outline their preferences for end-of-life care. As a result, it’s easier for providers to honor their wishes. Often, their cost of care decreases too. Understanding the importance of advance care planning and its benefits for both patients and providers can help move medical practices toward a more comprehensive value-based care model.
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Since the adoption of the 2023 Final Rule requiring ACOs to adopt Alternate Payment Model Performance Pathway (APP) quality reporting by performance year 2025, many ACOs have been scrambling to understand how to make the leap. There’s a huge difference between the old method of quality reporting using the CMS Interface to report on a 248-patient sample and the new requirement for APP reporting on all practice patients, regardless of payer type. The sheer size of reporting volume and mechanics means that your ACO will need to aggregate practice EHR data for the first time, even with fewer measures under the APP. If yours is a multi-practice ACO with no prior investment in data infrastructure—the norm, except for population health— this is a major undertaking. To meet the deadline, your ACO may be one of many feeling pressured to look for the “easy, fast” path to APP reporting. But that’s just magical thinking. Here’s the reality…
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UPCOMING WEBINARS:
Succeeding in Traditional MIPS (While You Still Can)
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Topic: Developing and deploying a traditional MIPS strategy that earns incentives (and avoids penalties) now, and leads to future success
June 27, 2023 | 1 PM EST
MIPS Value Pathways (MVPs): How to Succeed in Post-Traditional MIPS
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Topic: Creating and implementing an MVP strategy now that will provide an advantage in the future
July 11, 2023 | 1 PM EST
Healthjump Client Product Review: Harnessing EHR Data to Save Time for Practices
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Topic: How Healthjump's innovative EHR platform has revolutionized practices with seamless integration, workflow efficiency, and financial advantages
July 13, 2023 | 1 PM EST
RECORDED WEBINARS:
Ongoing OIG Risk Adjustment Scrutiny: Top 3 Key Insights for ACOs, Payers, CINs and Providers
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Topic: Understanding OIG Risk Adjustments audits, learning to identify potential audit threats, and developing solutions to mitigate risk, elevate member quality-of-care, and improve outcomes
Check our our Webinar Archive to view past webinars on a variety of value-based care related topics!
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2023 Virtual National Advanced Healthcare at Home Summit
July 11-14, 2023 | Virtual
RISE West 2023
August 28-30, 2023 | Dallas, TX
Activate2023
September 27-28, 2023 | Minneapolis, MN
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ReferralPoint is a referral management solution for health systems, medical groups, and payers to transform their patient referral processes and support their fee-for-service and value-based care populations. Built on a top-performing population health platform, ReferralPoint uses cost and quality data to inform referral decisions to the highest quality, lowest cost, in-network providers then automates insurance verification, prior authorization, scheduling, and closing the loop. Seamless integration allows partners to increase revenue and savings, reduce leakage and costs, improve efficiency, and enhance patient satisfaction, all from within their EHR workflow.
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