Winning a Gold Medal for Alternative Payment Model ParticipationParticipating in the Olympic Games can create career-defining moments for elite athletes. Similarly, healthcare providers that participate in alternative (or “value-based”) payment models can yield desirable benefits for themselves and their patients. These models are intended to incentivize a greater continuity and coordination of care between providers, leading to better patient outcomes at lower costs. An example of an alternative payment model is the bundled-payment system. Through this system, a single (i.e., “bundled”) payment is made to all providers involved in an episode of care – that is, a group of services provided to treat a particular condition – for a single patient. This payment is then divided appropriately among the providers.

As the U.S. population ages, demand for post-acute services continues to increase. As a result, alternative payment models are becoming an even higher priority for the healthcare industry. In fact, an estimated 30% of Medicare payments are now tied to quality and value through alternative payment models. The Department of Health and Human Services (HHS) hopes to increase this number to 50% by 2018.

Passing the “Torch” of Patient Data

Value-based payment models are expected to lead to a significant narrowing of post-acute care networks. Care coordinators are becoming more selective in their choice of post-acute care providers, using powerful analytics software and historical data to identify preferred providers based on key quality-oriented performance indicators and information-sharing capabilities. Performance indicators will focus on efficiency and effectiveness of care, including – but not limited to – such measures as the average length of stay, 30-day re-hospitalization rates, post-acute readmission rates, infection rates, functional independence measures scores, and patient satisfaction scores.

Successful bundling arrangements require strong communication networks between participating providers. Given that multiple providers can be involved in a single patient’s care, the potential for duplication of services and adverse drug reactions is high. By sharing information with each other, providers can not only help address these risks but also take important steps toward providing better care at a lower cost.

Additionally, the effective use of patient data may help identify a provider’s highest-risk patients and measure their likelihood of needing future acute services. Such a measurement could help providers better plan and monitor care to mitigate patient risk. Clinical care may be streamlined through better automation and delivery of the high-quality information needed for making appropriate care decisions.

Establishing “Sportsmanlike” Participation Strategies

Just as the Olympic rings are linked together, post-acute providers may want to consider implementing strategies and procedures that help facilitate communication. Such procedures may help improve productivity, reduce costs, and demonstrate continuous improvement in quality metrics – all of which will most likely rely heavily on a data-driven-care model. Given the importance of successful communication in the alternative payment models, those with Health Information Exchange (HIE) access and standardized formats for sharing health records with each other could have a better chance at positioning themselves as preferred providers. Participating providers may also choose to implement systems that monitor and report quality and patient satisfaction measures. Most payment-share agreements under these models are designed to adjust reimbursement based on performance against quality, efficiency, and patient satisfaction metrics.

Let CRI Help You Be a “Frontrunner” Value-Based Payment Model Participant

The post-acute care market is facing significant challenges. Increasing demand, pressures on reimbursement, and the move to value-based payment models create an environment of high uncertainty and risk. Providers who recognize the crucial role of health information technology and develop strategic operational plans to leverage health information to manage care, improve outcomes, and reduce costs are more likely to be better positioned for success.

Just as participating athletes and judges commit to the Olympic Oath, CRI is committed to helping you incorporate value-based payment models into your healthcare organization. Contact us to start training today!