Value-based care links healthcare payments to the quality and success of the care given. It focuses on patient results while controlling costs. Since the Affordable Care Act of 2010 and programs like the Medicare Shared Savings Program (MSSP) and the Quality Payment Program (QPP), more providers have joined value-based care models.
CMS says value-based care programs connect payments to how well providers do on measures of cost, quality, and patient experience. Around half of Traditional Medicare patients in the U.S. are now part of accountable care setups, like Accountable Care Organizations (ACOs). These groups have shown savings and better health results.
Two key CMS programs, MSSP and ACO REACH, show this progress. MSSP has about 480 ACOs serving over 10.8 million people. In 2022, it saved Medicare $1.8 billion and paid $2.5 billion to groups involved. ACO REACH focuses on health equity and provider leadership and covers more than 2.6 million people. Starting in 2025, primary care doctors in ACO REACH will get 100% fixed payments for primary care, dropping the fee-for-service method.
Switching from fee-for-service to value-based care can be hard. Administrators face complex rules, changing payment models, and more reporting tasks. Providers may feel burned out because VBC means extra work like patient teaching, care coordination, and careful data tracking.
Data systems that don’t work well together cause problems in coordinating care. This can lead to inefficiencies. Money can be unpredictable since payments depend on meeting quality goals instead of just counting services. Practices must balance risks of penalties with rewards for good quality and cost control.
Even with these issues, new strategies and technology can help practices meet quality goals and take part effectively in incentive programs.
Electronic health records (EHRs) are key to managing paperwork, care coordination, and reporting in value-based care. Specialty-specific EHRs help improve workflows and make tasks easier. For example, athenahealth’s athenaOne platform lets clinicians use workflows made for their specialty. This helps them document visits faster, use templates, and apply shortcuts.
These systems provide real-time patient information that helps providers spot care gaps or missed tests. Mobile features let doctors enter data from anywhere, making workflows more flexible. For example, a cardiology practice using these tools closed 95.3% of encounters the same day and increased collections by nearly 80% in two years.
These EHRs also support telehealth, which can improve access and keep schedules full, especially in rural or underserved areas.
Good care coordination is important in value-based care. Practices should use shared care plans, promote teamwork communication, and ensure smooth patient transitions. ACOs and similar groups use shared-risk plans to better manage patients and improve results.
Tools that support virtual communication, telehealth, and patient involvement help practices follow care plans. This lowers unnecessary hospital and emergency visits. Programs like the CMS Enhancing Oncology Model (EOM) offer 24/7 clinician access and patient help, improving coordination without extra cost to patients.
Having accurate and current data is needed to do well in value-based programs. Practice leaders should invest in tools that track quality, patient satisfaction, readmission rates, and costs.
Reviewing data regularly helps find ways to improve and adjust care to patient needs. CMS offers public data on hospital performance for quality benchmarking. Predictive tools can also help decide where to put resources and staff.
Since rules and reporting often change, staying updated with CMS and using flexible systems is important.
Payments in value-based programs depend on meeting benchmarks and controlling costs. So, financial planning needs to include risk management.
Joining advanced payment models (APMs) means taking on some financial risk but gives higher rewards and fewer reporting demands like MIPS. Proper contracts, accurate patient assignments, and strong revenue systems are needed.
Practices in MSSP and ACO REACH show that ACOs focusing on primary care with many primary care doctors save nearly 30% more per person. This shows financial benefits when providers focus their strategies.
Artificial intelligence (AI) and automation are becoming important for practices handling value-based care work. These tools reduce paperwork, improve note accuracy, and make patient management easier.
AI-Powered Documentation: Tools like athenahealth’s Ambient Notes use language processing to write clinical notes from doctor-patient talks. This cuts the time doctors spend on paperwork and lets them focus more on patients.
Voice Recognition and Hands-Free Support: AI voice tools let clinicians finish notes and tasks without typing. This makes work simpler and stops interruptions during visits.
Automated Scheduling and Call Management: AI phone systems, like Simbo AI, help patients get through, lower missed appointments, and handle calls better. These systems answer calls smartly, direct questions to the right person, and ease the work for office staff.
Predictive Analytics: AI looks at patient data to guess risks like hospital readmissions. Providers can then take action earlier, fitting value-based care goals.
Care Coordination Automation: AI spots care gaps and reminds providers about follow-ups or prevention steps. This helps follow care plans and boosts quality scores.
Using AI, practices can work more efficiently, cut costs, and do better in quality incentive programs. Also, automation can lower stress for doctors and staff, which is helpful during changes to value-based care.
Small and rural practices often have special challenges in using value-based care. CMS provides resources like technical help, training, and money incentives to support these providers.
Interoperable EHRs and telehealth are very useful for these groups. They help overcome distance and lack of resources. Flexible workflows and automation also allow small teams to keep good documentation and reporting without too much extra work.
Following changing rules like MACRA, MIPS, and APM requirements is an ongoing job for value-based care practices. Technology updates from vendors help keep systems compliant without stopping care or business.
Going forward, health equity bonuses in MSSP encourage practices to serve underserved groups. New models will ask providers to take fixed payments and focus more on primary care’s role in managing costs and outcomes.
More cooperation between payers and providers will be needed to align payments and share quality and cost data well. Use of digital tools and AI in managing population health will grow, letting providers target interventions and resources better.
By following these steps and adding new technology, medical practices in the U.S. can better manage value-based care, improve quality, and succeed in quality incentive programs.
The primary goal of athenaOne’s EHR is to enhance patient care and improve efficiency by offering intuitive and configurable workflows that facilitate care coordination and keep patient records current.
AthenaOne reduces clinical administrative burden by providing specialty-specific workflows, enabling documentation for in-person and virtual visits, and including features like best-practice templates, macros, and accelerators.
AthenaOne surfaces actionable insights from across its network directly within clinical workflows, helping clinicians identify and address potential diagnosis and care gaps.
Mobile documentation allows clinicians to document encounters and complete clinical tasks using customized templates and macros on their mobile devices, improving access and efficiency.
Telehealth expands patient access to care by enabling remote consultations, thereby improving schedule density and enhancing the overall patient experience.
AthenaOne equips providers with workflows, tools, and expert support to boost performance in quality incentive programs and manage improvement opportunities effectively.
Ambient Notes is an AI-powered tool designed to automatically generate clinical notes, thereby alleviating documentation burden and improving efficiency and patient experience.
Voice-powered services provide AI-driven hands-free support for documentation and other clinical tasks, simplifying workflows and reducing the time spent on administrative duties.
AthenaOne performs regular, discreet system updates to ensure that the software remains current and compliant, without causing interruptions to clinical care or business operations.
Specialty-specific workflows within athenaOne help streamline documentation by surfacing relevant testing results and ensuring that the documentation process aligns with the unique needs of each specialty.
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