Value-based care (VBC) models are rapidly gaining prominence in the healthcare industry, revolutionizing the way healthcare is delivered. To ensure that provider organizations make the transition, the Centers for Medicare & Medicaid Services (CMS) has implemented several initiatives that offer incentives in favor of performance-based payments. These include alternative payment models such as Medicare Shared Savings Program (MSSP) and bundled payments, among others.
While Accountable Care Organizations (ACOs) have been leading the charge in this transformation, CMS has also set an ambitious goal of achieving 100 percent participation of Medicare beneficiaries in accountable care relationships by 2030. However, provider organizations face numerous challenges that may impede their readiness to adopt a value-based care model. A recent report by HealthLeaders revealed that nearly half of the surveyed provider organizations were uncertain about their ability to successfully transition, with 17% expressing doubts about meeting the CMS goal.1
Overcoming challenges in advancing value-based care
One significant obstacle facing provider organizations is the existing fee-for-service reimbursement system, which incentivizes volume over value. Shifting to a value-based care model requires a fundamental change in an organization’s financial structure and reimbursement mechanisms, which can be daunting and financially risky. Additionally, provider organizations may lack the necessary infrastructure and technology to effectively collect, analyze, and share data across different care settings.
These challenges include:
- Complex Data Sets: VBC data is fragmented and intricate, requiring substantial time and resources for processing and upkeep. As highlighted in the Harvard Business Review’s article, “What Data Scientists Really Do According to 35 Data Scientists,” Accountable Care Organizations (ACOs) spend a significant portion of their time (at least 80%) on data preparation, struggling to convert it into a manageable format. This challenge is exacerbated by limited resources dedicated to data analysis within ACOs, often compounded by a lack of experience in effectively utilizing analytics and population health management resources.
- Limited Technology: ACOs often face the challenge of relying on manual processes and siloed technology. The combination of electronic medical record (EMR) system’s analytics modules, Microsoft Excel, and business intelligence (BI) software can hinder their ability to concentrate on strategic initiatives and extract valuable insights.
Without the right data and tools in place, ACOs may find it difficult to track and measure patient outcomes accurately, a crucial aspect of achieving VBC success.
Transforming VBC with data-driven insights
To achieve success in value-based care, ACOs can utilize advanced analytics to unlock the vast potential of their data. This enables them to optimize resources and redirect their focus towards delivering high-quality and efficient healthcare services. By leveraging analytics, ACOs can more proactively work with their performance-based populations, analyze potential cost-reduction strategies, and manage alternative payment contracts. This newfound insight empowers ACOs to make strategic, informed decisions that improve efficiency and financial sustainability –allowing for the allocation of resources where they are most needed and ensuring that patients receive the care they need without compromising quality.
The power of MedInsight’s VBC Platform
As CMS continues to drive the transition towards value-based care through various models (e.g., bundled payments, pay-for-performance programs, shared savings, capitation, etc.) having a reliable data engine is key to your success. To support your organization in this shift, MedInsight’s VBC Platform is designed to be scalable, intelligent, and user-friendly according to your organization’s level of risk.
With our VBC Platform, your organization can achieve several key benefits:
- Improve Care Coordination, Quality, and Costs: Facilitate greater care collaboration with insights into coding gaps that enable increased quality and risk management. By identifying areas for improvement, you can work towards shared goals and enhance patient care while optimizing costs.
- Optimize Efficiencies and Outcomes: Align clinical, business, and compensation models on a single system. This integration strengthens provider buy-in and trust, as they can rely on proven analytics and insights that reflect the unique goals of your organization. By streamlining processes and aligning incentives, you can optimize efficiencies and improve patient outcomes.
- Increase Performance, Satisfaction, and Profitability: Identify more opportunities to redirect patients to appropriate, in-network care. By optimizing valuable resources, you can improve outcomes, risk adjustment, and revenue. This not only enhances performance and profitability but also increases patient satisfaction as they receive the right care at the right time.
Contact a MedInsight analytics expert to learn more about our VBC Platform and how MedInsight can help your organization prepare for the future of value-based care.
- Balancing the Risk and Reward of Value-Based Care Intelligence Report, Health Leaders, May/June 2023