Amid the era of value-based care (VBC), the healthcare industry continues to transition away from traditional fee-for-service reimbursement to payment models that prioritize improving overall patient outcomes and lowering care costs.
Results show that we’re starting to reap the benefits of VBC. For example, the National Association of Accountable Care Organizations (ACOs) announced that in 2020, Medicare savings increased to $4.1 billion through value-based payment models. That’s a ten-fold increase since HHS’s 2015 report of only $417 million in savings.
With the promise of further reducing spending as well as improving quality of care, CMS is making a significant push to transition Medicare members in an accountable care relationship to value-based reimbursement models sooner than later via its Innovation Center Strategy Refresh. The goal is to route all payments through its VBC models by 2030. Concurrently, CMS is working to align Medicare Advantage (MA) reimbursement to similar programs.
Even if a provider is not part of an ACO, chances are they provide care to MA members, since they make up around 45% of Medicare enrollment. And many commercial insurers have set up their own VBC systems that are similar to the CMS model. Therefore, it’s in the provider’s best interest to address any potential VBC data-sharing challenges and implement the appropriate workflows now, not only avoid penalties, but make the most of incentives that reward value today and in the future.
To do this effectively, health organizations need to leverage predictors of patient outcomes alongside patient data, which can be made possible with patient engagement.
Shifting the provider focus
Providers using the right patient engagement platforms can better manage, track, and treat high-risk or potentially high-cost patients. Historically, managing complex patient populations with chronic conditions and challenging social determinants of health was labor-intensive, if not impossible, due to a lack of available data, staff, and automation tools.
However, population health management initiatives supported by sophisticated, integrated, and automated patient engagement tools can make a huge difference for providers in their approach to care.
A focus on strengthening communications between providers and patients outside of the visit empowers providers with the results of the treatments they provide during the in-person encounter. Utilizing patient engagement tools, such as secure messaging, patient surveys that capture patient-reported outcomes (PROs), and virtual visits, gives providers the opportunity to track VBC measures and confirm care plans are working, or pivot to adjust care plans to obtain better results.
Increased efficiency created by automated patient engagement tools not only can improve VBC outcomes but allow care teams to focus on care delivery and improving their patients’ health rather than the repetitive, manual administrative tasks that would be necessary if modern patient engagement tools were not available.
Creating targeted population health campaigns
Population health management strategies enhanced by patient engagement can produce multiple data streams to optimize care delivery and understanding for multiple diagnosis or procedure criteria concurrently. Having the full healthcare picture allows providers to create targeted health campaigns designed to inform decisions regarding the most relevant and effective interventions for each patient.
By collecting and analyzing data using a comprehensive population health management tool, such as integrated patient engagement tools that find patients according to their diagnosis, providers can ensure that data is standardized and inserted into the patient record within EHR. Additionally, by pairing EHR and practice management system data with patient-generated health data through surveys, providers are able to gain a 360-degree view of their patients, including the health risks for various patient populations. This actionable data enables proactive and preventative interventions to keep high-risk patients out of the emergency room while improving efficiency and optimizing care.
The best patient engagement technology allows health care organizations to avoid and minimize the barriers to successful population health management. These comprehensive patient engagement solutions improve the patient journey and their health, ultimately enabling providers to meet VBC goals. The result is improved overall care delivery for any population as well as sustainable financial success for years to come.
This article was originally published on Healthcare Business Today on August 28, 2023. You can view the article here.