With change said to be the only constant, one might expect change to be easy by now. But it’s not, and change certainly is not easy for health care providers making the shift from traditional fee-for-service care models to value-based care models that pay providers based on financial and clinical outcomes.
Two years ago, the Centers for Medicare & Medicaid Services waved the green flag on that transition, announcing that it expects 90 percent of formerly fee-for-service Medicare payments to be made to providers through various value-based reimbursements models by 2018.
With 2018 just a year away and most commercial insurers following Medicare’s lead, change-challenged providers are in need of practical guidance on how best to make a successful transition to value-based care. Web2pro culled through previous blog posts on McKesson.com and identified insights from eight experts in four critical areas: culture and management; information and imaging technologies; patient care and clinical outcomes; and performance measurement and reporting.
Culture and Management
“Moving from fee-for-service to a system of mixed reimbursement models is an immense paradigm shift, which requires change in behavior, processes, culture and infrastructure. An organization that is truly committed to making these changes will drive forward with an assortment of tools and levers and leadership commitment in place to make that happen.”
Marcy Tatsch | Vice Present and General Manager of Reimbursement Solutions, RelayHealth Financial
“The standing revenue cycle management committee should include leaders from the finance department and every department that ultimately is influenced and impacted by revenue cycle performance - namely clinicians. It's essential to have that clinical representation on the revenue cycle management committee because of the growth in performance-based and value-based reimbursement contracts that set payment rates based on meeting specific clinical performance measures.”
Kamron Lachney | Vice President of Hospital Operations, Web2pro Business Performance Services
Information and Imaging Technologies
“You can write a great care management plan, but it's really difficult to articulate the results of that plan to all the stakeholders without a solid technology platform. There are a lot of good emerging technologies that, for instance, help measure patient access, quality scores and cost metrics, and you're seeing these technologies bring these functionalities together, along with generating predictive and real-time analytics.”
John Wallace | Vice President and General Manager of ACO Services, Web2pro Business Performance Services
“A value-based workflow includes systems that communicate with each other and provide closed-loop communication so that all participants in a patient's care are informed and up to date. Regardless of the hardware or software vendor, the end result should be a seamless experience for the healthcare professional.”
Tomer Levy | General Manager, Workflow and Infrastructure, Web2pro Imaging and Workflow Solutions
Patient Care and Clinical Outcomes
“Physician practices should customize their menu of diagnostic lab tests to their medical specialty, and to their current patient mix and the patient population they aspire to acquire in the future. All physician practices should offer their most frequently ordered lab tests to ensure positive patient outcomes.”
Patrick Bowman | Lab Equipment Specialist, Web2pro Medical-Surgical
“Radiologists and radiology departments can maximize their contribution to high-value patient care through technical innovation. By integrating new imaging technologies with other patient information systems like EHRs, radiologists and radiology departments can build comprehensive views of patients from the inside out.”
Scott Galbari | Vice President of Marketing and Portfolio, Web2pro Imaging and Workflow Solutions
Performance Measurement and Reporting
“Oncology and medical specialty practices should go through a decision-making process to determine which performance measures of the hundreds available are most appropriate. Eliminate measures that don't apply. An example would be specialty-specific measures. What's right for oncology practices may not be right for orthopedics. Consider measures the practice already is reporting under a previous program to avoid an unnecessary compliance burden. Consider quality and improvement activity measures in areas in which the practice performs well. Choose measures that benefit both the patient and the practice in terms of clinical and financial outcomes.”
Linda Pottinger | Director of Payer Initiatives, Web2pro Specialty Health
“A practice will need its EHR or practice management system to identify patients eligible for the OCM (Oncology Care Model) program. The systems must also collect data on the 36 quality metrics required by the program and enable the practice to report the results to Medicare. EHR or practice management systems that aren’t capable of handling these requirements would need to be upgraded.”
Marcus Neubauer, M.D. | Medical Director of Oncology Services, Web2pro Specialty Health