As a result, patients reported better health outcomes and greater satisfaction with their providers. In fact, providers in VBC networks had 26 percent higher Healthcare Effectiveness Data and Information Set (HEDIS) scores than FFS providers. Humana also reported that its providers had 11 more points on engagement and provider-satisfaction scores. Value-based care has potential to improve quality of care and help some providers become more competitive.
With that in mind, VBC is a significant departure from the FFS model and will, therefore, require a shift in the types of patient data that practices collect, as well as some adjustments to existing revenue cycle management methods. But considering the positive outcomes recorded so far, the shift to VBC is a great opportunity for specialty practices. This is especially true considering the wealth of technological resources that are now available to help practices make the transition.
The VBC trend is part of the Medicare Access and CHIP Reauthorization Act's (MACRA) Merit-Based Incentive Payment System (MIPS). As of 2017, qualifying providers that demonstrate high-quality healthcare for patients can receive a Medicare reimbursement incentive. Conversely, providers that fail to demonstrate value may see lower reimbursements. In essence, MIPS (and Alternative Payment Models, or APMs) are value-based care incentive programs (read more about MACRA/MIPS here).
This means practices that have already begun preparing for MACRA/MIPS or MIPS APM are the first VBC providers. Every provider that qualifies for MIPS receives reimbursements based on several factors. The most heavily weighted of those factors is "Quality Measures" – in 2018, MIPS practices must select six specific metrics to measure quality of care. Each of these will have a unique criteria for the data collection.
Incidentally, these Clinical Quality Measures (CQMs) focus on the value-based care model. This means that practices using a MIPS-friendly EHR achieve two things at once: They simplify tracking of CQMs while also becoming a VBC provider.
The following represents some of the key areas where CQMs promote VBC:
A MIPS-friendly EHR makes it easier to track the above metrics, both for CQM purposes and for VBC billing enablement. While the former is a requirement for many practices, the latter has potential to help clinicians gradually move away from the FFS model to deliver more value to patients, and ultimately improve patient engagement and financial stability.
AllMeds' MIPS-friendly EHR for specialty practices is a great first step toward a VBC model. Nevertheless, many practices may need additional assistance as they become acclimated to MIPS. Whether you're just trying to boost your Medicare incentive, or you are depending on the results of the Quality measures to improve patient care, the experts at AllMeds will make sure you have the processes, expertise and technology needed to make change simple and painless for your practice.
Click here to learn more about how MIPS|assist™ can help you realize greater Medicare reimbursements and move toward a value-based care model.