Volume to Value Based Care Delivery – Are Health Systems ready to match the pace?

In US Healthcare, the paradigm shift from Volume to Value Based Care delivery model is fast-paced.

HHS already reached the goal (ahead of the schedule) of tying 30% of Medicare payments to alternative payment models (categories 3 & 4) that reward the quality of care over quantity of services provided to beneficiaries. And the goal is to achieve 50% by the end of 2018. HHS has also set a goal of tying 90% of all traditional Medicare payments to quality or value (categories 2 through 4) by 2018.

With MACRA (The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015), the Centers for Medicare & Medicaid Services (CMS) has taken a significant step in this transition to value based care delivery model. +/-4% to +/-9% payment adjustment till 2022 will be made to participants under MIPS (Merit-based Incentive Payment System) and additional incentives will be made for high performers. APM (Alternative Payment Models) participants who are not eligible (for Advanced APM incentive payment) will receive favorable scoring under MIPS. 5% incentive payment will be awarded each year from 2019-24 to eligible participants for participation in Advanced APMs.

The new reforms and regulations are implicitly compelling the Healthcare Enterprises to adopt various value-based alternative payment models. Hence, there is a significant need for health system networks to improve their operational efficiency and deliver quality care with better outcomes. Below are some of the challenges and needs of health systems.

  • Effective patient/family engagement and experience
  • Aggregation of Data from multiple sources to ensure accuracy and consistency
  • Demand for highly coordinated and collaborative care due to involvement of multiple stakeholders in value-based care models
  • Need of Decision Support Systems & Actionable Insights to improve the quality of care and efficiency
  • Need to optimize operational processes to improve overall productivity and reduce the cost of care

Considering the challenges and needs of highly coordinated, collaborative and efficient care models, a robust ecosystem with technology as a driving force will be a game-changer for healthcare enterprises.

This aligns well with our vision of Software 4.0 – a world in which organizations move from being software-enabled to being software-driven.

Being a Platinum partner of Salesforce, we have collaborated in the development and deployment of solutions in the Healthcare space. We have an ecosystem of solution offerings/technology components (mentioned below) which can aid Health Systems to thrive in Value Based Care models.

This solution kit will also aid providers in kick-starting their MACRA compliance in following ways:

  • The solution kit provides coverage for almost all categories of CPIA (Clinical Practice Improvement Areas) under MIPS program
  • Though the Quality Reporting and Data Submission will happen through Certified EHR or qualified registries, the platform provides seamless integration with Certified EHRs.
  • The solution kit has coverage for key measurement areas of APMs like Patient/Caregiver Engagement, Care Coordination, Population Health & Prevention, Safety & Clinical Care etc.
  • Moreover, with Provider Network Management, the solution kit also offers the capability to manage operational / non-clinical aspects of MACRA compliance (like Contract Management, Performance Tracking, Partner portal, etc.)

Below is the glimpse of our solution offerings.

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Click here for more details on our offerings.

Thanks for reading. We would like to hear your thoughts, views, and comments on this topic.

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