Value-based care is a major step for practices to prove quality of care when it comes to reimbursement. As Centers for Medicare & Medicaid Services (CMS) introduces new programs for reimbursement, providers using the old method of fee-per-service see less returned to them. These CMS programs focus on the quality of care over the quantity of care. Providers can be confused as to meet quality measures, but EHRs can help prove efficiency and get practices paid.

Value-Based Care: What is it?

Put simply, value-based care is a system that looks at the quality of patient outcomes as thresholds for reimbursement, not the quantity of patients treated. CMS’ new programs focus more on how providers can improve patients’ health. This new system involves collecting more information from the patient and being able to track their progress through their care plan. Some examples of these programs include:

  • Merit-based Incentive Payment System (MIPS)
  • Value Modifier (VM), also known as Physician Value-Based Modifier (PVBM)
  • Home Health Value Based Program (HHVBP)
  • Alternative Payment Models (APMs)
  • Patient-Centered Medical Home (PCMH) model
  • Primary Care First (PCF)
  • And more…

Value-based care models vary based by specialty, but their importance doesn’t change. Practices interested in receiving reimbursement from CMS need to work with whatever model is most relevant to maximize their cashflow.

Meaningful Measure Objectives in Value-Based Care

Value-Based Care - Next Steps

Each reimbursement program includes a list of meaningful measure objectives. Being able to prove a patient’s quality of health has increased ties directly into how the provider is reimbursed for their services. While the old fee-for-service model meant that the more tests that were run, the more they received for reimbursement. In theory, this should be good for patients – they’re getting thorough testing.

However, with these new value-based care models, providers can more accurately track how a patient is progressing in their care plan. They can do that thanks to the meaningful measure objectives that each system requires. Instead of looking at how many tests were rendered, other metrics are now weighed more heavily.

For example, the Patient-Centered Medical Home (PCMH) model focuses on the patient outcomes when patients have more direct one-on-one time with their primary care provider. This model is credited with a reduction in healthcare costs, an increase in preventative services, and improving care coordination with patients who may have complex needs with their care. Colorado’s Multi-Payer PCMH Pilot cut ER visits by 15% and inpatient admissions by 18%, while achieving a return on investment of $4.50 for every dollar spent. Being able to track those outcomes proves that providers are taking the proper steps to care for their patients, improving quality of life, and seeing a larger reimbursement.

Supporting Value-Based Care with EHRs

Beginning a value-based care plan can seem incredibly daunting to established practices or to a new practice that’s just starting out. It involves tracking possibly new data and being able to report on it. With the right EHR, this process can be simple.

An EHR with customizable reporting capabilities supports a practice’s mission to be able to track meaningful measure objectives. By capturing that information at the time of service, and running quarterly, or even monthly, reports will help ensure practices are on the right track. The best part is with this reporting, if these objectives aren’t being met, practices can more easily identify where improvements can be made. Not only will this increase reimbursement, it will also improve quality of care for patients – the ultimate goal of a value-based care system.

It is important that your value-based care initiatives are supported. To learn more about EHRs that can support a practice’s value-based care initiatives, click here.

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