What is Value-Based Healthcare?
According to the Centers for Medicare & Medicaid Services (CMS), value-based healthcare programs are designed to reward health care providers with incentive payments for the quality of care they give. Value-based healthcare represents a shift in how providers deliver care to their patient populations. It’s also a shift away from the traditional fee-for-service (FFS) payment model.
Value-based health care awards providers for achieving certain benchmarks on measures set by federal and commercial payer’s programs. These federal and commercial measures are in place to encourage higher quality care and lowered healthcare costs for providers and payers.
A handful of diseases drive up the cost of healthcare for everyone. A value-based approach manages utilization to reduce over testing, an example of which is an overuse of radiology. The measures used in commercial and federal payers’ metrics represent the effort to improve outcomes for certain disease states and populations.
Value-Based Healthcare Contracts: Federal vs. Commercial
There are two types of payers for value-based care contracts: federal and commercial. Federal contracts are currently offered through CMS and include programs such as the Quality Payment Program (QPP). The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) fall under the QPP.
Commercial contracts are similar but are offered by commercial insurance companies instead of the federal government. Several major commercial healthcare providers offer value-based healthcare contracts, including Aetna, Cigna, Humana, United Health, and Anthem Blue Cross Blue Shield, among others.
These healthcare payers all have the same goal — to provide great quality care and lower the cost for everyone involved; payer, provider, and patient.
Choosing the Right Contract
Each contract has a different set of requirements and measures benchmarks. Not every provider is eligible for every type of contract. When it comes to contracts that fall under QPP, the CMS website has a tool to confirm a provider’s eligibility. There’s also a tool to check the participation status of a provider. Contracts from commercial payers also have specific requirements and measures benchmarks. These will vary between commercial payers.
Understanding and evaluating your patient population is another key item to consider when choosing value-based contracts. If a large portion of your patient population uses Medicare or Medicaid, pursuing contracts through CMS could be beneficial. If a significant portion of your patients doesn’t engage with CMS services, pursuing contracts through a commercial payer could yield greater financial returns.
Pursuing a federal contract doesn’t disqualify you from pursuing a commercial contract, and vice-versa. Regardless of which contracts you pursue, your office needs to aggregate a large amount of data for submission. This can take a huge amount of time and effort on the part of your staff. An easy way to collect all your data is by using Measures Manager™.
Use Measures Manager™ to Track Contract Performance
Measures Manager™ is a value analysis tool which aggregates data and tracks the performance of quality measures across all value-based arrangements. The core result of using the tool is to close care gaps—those events which should take place as part of meeting a measure benchmark but have not occurred yet—by easily understanding eligibility for a measure and by using clinical data from an EHR to prospectively identify those patient care gaps and then close them. Meeting value-based care measures in quality and utilization is key to performance which results in attaining the incentives such as shared savings. A streamlined dashboard allows you to easily identify providers or offices in danger of not closing measures gaps. You can gauge your measures performance at a glance through these simple charts, graphs, and totals.