With Americans “fed up with high healthcare costs and surprise billing,” Centers of Medicare & Medicaid Services (CMS) Administrator Seema Verma is calling on healthcare providers to embrace value-based care, because it’s the future, she says. “If your business model is focused merely on increasing volume rather than improving health outcomes, coordinating care and cutting waste, you will not succeed under the new paradigm,” Verma recently told a group of healthcare executives.
As CMS moves forward to make value-based care a reality for consumers, the question becomes clear: What must post-acute care providers do to succeed in a performance-based world where outcomes are prioritized? Start with your data.
When outcomes are prioritized, data becomes king.
Without data, it’s impossible to prove your value to payers and referral sources such as hospitals and health systems. The data and, more importantly, the insights that come with it, is your linchpin to succeeding in an outcomes-based healthcare environment.
As payers narrow their networks and hospitals become more selective in the out-of-hospital providers they choose to partner with, post-acute providers must ask themselves: Do I have the data analytics capabilities to prove my value to hospitals and payers?
Post-acute providers who can use their electronic health record (EHR) data and data from other organizations to lower cost of care, reduce unnecessary hospital readmissions and eliminate duplication will become the winners with value-based contracts.
The problem is that the majority of post-acute care facilities don’t have the data analytics capabilities to prove their value. “Most long-term care organizations are still stuck in a volume-based mindset," said Doug Brown, Managing Partner of Black Book Research. And many admit they are not prepared to take on value-based contracts, says Brown.
Only 4% of inpatient long-term care providers reported having the capabilities of data-driven analytics to lower cost of care, reduce unnecessary hospital readmissions and ensure facilities receive proper reimbursement for the care provided to the patient, according to Black Book Research.
Value-based care requires data aggregation, provider communications and analytics. As a post-acute provider, you must be able to transform data into actionable insights.
Healthcare’s big ticket is the conversion of information into insights.
You must also be able to view data that allows for a total understanding of your business (i.e. total cost of care, risk, regulatory compliance, competitive strengths/weaknesses), so you can gather insights to make necessary changes.
Data insights and analytics will help you understand the potential risk of an individual in your care, so you can act proactively, not reactively. Without data analytics, you miss opportunities to provide appropriate treatment and improve recovery. What’s more, failure to identify or target at-risk consumers has financial implications in the form of hospital readmissions and extended treatment.
Legacy EHRs built to address episodic, fee-for-service reimbursement models won’t serve you well in value-based reimbursement models. Before making any technology purchase, it’s critical to make sure your technology vendor has a cross continuum platform designed to support sophisticated data analytics and patient/provider access to complete data. (see A single platform to meet all your needs)
Tracking key performance indicators (KPIs) is an essential step to becoming a truly data-driven organization. A healthcare data analytics platform that provides at-a-glance metrics to clinical, financial and operational decision-makers will help you determine if you are achieving organizational goals and meeting regulatory compliance – two areas critical to value-based care.
Data intelligence is also a necessary component of any referral strategy. Nowhere are referrals more important than in post-acute care. Because analytics help you understand your business, you can better market your strengths to referral partners, while you optimize areas that need improvement. (see Do you want more referrals?)
As you transition from fee-for-service to fee-for-outcomes, you will need to ask yourself:
1.) Does my business model support value-based care, so I can succeed with risk-based contracts?
2.) Can my EHR adapt and scale to meet the fast-changing regulatory requirements?
3.) Are my revenue cycle processes positioned to meet new payment designs, like the Patient-Driven Groupings Model (home health) and Patient-Driven Payment Model (skilled nursing)?
These new payment designs are only the beginning. More will come as CMS pushes our healthcare system to a consumer-centered model.
Dawn Iddings leads the post-acute care team at Netsmart, a healthcare IT company that provides EHRs and business services to more than 30,000 post-acute care and human services organizations.
To learn more about how Netsmart can provide you with a robust analytics ecosystem, visit here.
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