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Technology and value-based reimbursement

By Zachary Blunt, manager, product management
Greenway Health

Zachary Blunt, manager, product management

Preparing for value-based reimbursement is a challenge for many practices. In addition to undertaking the traditional fee-for-service billing workflows, which are still necessary, a practice also must be prepared to measure, report on, and improve quality while reducing cost.

It’s not a simple endeavor.

Congress and the Center for Medicare and Medicaid Services (CMS) have developed programs and regulations to help clinicians adapt to these payment arrangements, but these are complex in and of themselves.

Although the title of this blog is “Technology and value-based reimbursement,” we’re going to cover broader ground. With respect to the intersection of value-based care and technology, we’ve observed that successful organizations leverage their people and processes in conjunction with technology to maximize the efficacy of care delivery.

People

  • Dedicate a technology champion in the organization. Any piece of technology is only as good as the buy-in it has from the people who implement and use it. Dedicate somebody in the practice to act as an evangelist for the technology your organization has invested in, and try to involve them and your staff as you consider different tech stacks.
  • Invest in upfront and ongoing training when implementing an EHR or any other technology that has significant impact on workflows. Foundationally, clinical software is complex because there’s nothing more complex to document than a patient and his or her experience. Moreover, clinical information evolves over time as medicine advances. Couple that with the fact that software is frequently “agile” — or changing — and you have tremendous complexity in many products. However, several studies have demonstrated that investing in upfront training and ongoing refreshers can improve not only the efficacy of your technology, but your clinicians’ overall satisfaction with their jobs.
  • Make sure your staff has experience with clinical coding. This relates to the point about training. For any technology or analytics to deliver value, it must capture data in certain standards-based formats. Which formats you’ll use will depend on your measure selection. Make sure your staff has been educated about the importance of knowing what codes to use and when. Navigating the world of CPTs, ICDs, SNOMEDs, and LOINCs makes all the difference in terms of making sure you get credit for the services you deliver.

 

Process

  • Analyze your workflows to identify gaps with clinical quality measures (CQMs). Each CQM has a measure specification document that maps out what codes to enter so that the numerator of the measure will be populated when you report. Take each measure you report and examine the measure specification. Create a measure document with current practice workflows and conduct a gap analysis to see if you’re entering the right procedure, lab, and diagnosis codes for each measure you’ll report on. Then, where needed, adjust your clinicians’ workflows so your data is being captured.
  • Select measures that align across the programs in which you participate. Private payers, CMS, and accrediting entities such as the National Clinical Quality Association (NCQA) all use different sets of measures. Measures can vary across payers in nuanced ways that affect your workflows. They can even vary by submission mechanism (i.e. EHR vs. registry). Make sure they align to keep your clinicians’ workflows as simple as possible.

 

Technology

  • Leverage analytics to close performance gaps. Now that your processes are set up and your people are trained, you can take advantage of the full power of analytics. You can identify open care gaps for preventive screenings and annual wellness visits, which have no Medicare patient copay. You can also measure your clinicians’ performance over time. For those who are underperforming, you now have the data you need to engage in a conversation with them and share best practices.
  • Share data. The importance of sharing data cannot be understated. First, engage your medical neighborhood to establish interfaces within your referral network. Clinical data usually can be loaded daily, so you’ll have an ongoing view of patients’ visits through the system, such as hospitalizations at the local hospital. Next, make sure you have patient-level claims files from your payers, including CMS. Establishing claims data-sharing relationships may require a risk-based arrangement, but now is the time to begin those conversations and share your vision for reducing admissions for your most vulnerable populations. While claims feeds generally are 90 days in arrears, the benefit they bring is that the data is truly global. There is no HIE that can cover every medical institution in the United States. People travel.
  • Leverage 2015 CEHRT and patient engagement tools. The 2015 editions of Certified Electronic Health Record Technology (CEHRT) offer significant benefits. Care plans are now longitudinal and give you a more holistic look at a patient’s care and his or her progress. You also can change or cancel electronic prescriptions. Immunization registries are becoming bidirectional. Take advantage of these changes by upgrading sooner rather than later, and — going back to the first section of this blog — train your folks on the new 2015 CEHRT.
  • Use technology to connect with patients. A new cohort of beneficiaries is entering Medicare — members of the baby boom generation. These patients tend to be tech-savvy. Make sure you take advantage of this tectonic shift. Deploy a patient portal so patients can review their care plans and keep track of what their doctors tell them. Patient reminders can also play a role. For example, you could remind a patient to come in for a screening while delivering a link to education on how to prepare for the screening.

 

Training citations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377562/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540432/

https://link.springer.com/article/10.1007/s10916-013-9955-2