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Value-Based Care Model

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Independent Sales Partner, ISP, US Healthcare

EqualizeRCM Services‘ Partner, Dan Gallagher, Quatris Healthco, describes how physicians can adopt value-based care models in their practices using the Triple Aim framework.


Over 30 years ago a physician led group of visionaries at the Institute for Healthcare Improvement (IHI) identified the need to redesign health care. Fast forward to today we still utilize the framework created in 2007 by IHI called the Triple Aim. This revolutionary concept is known throughout healthcare and focuses on the health of a population, the experience of care for individuals within that population, and the per capita cost of providing that care.


Considerations When Targeting the Triple Aim

Regardless of the industry, getting paid for services provided is a timeless hurdle. It’s no different when applying this to medical practices. Sadly, it’s increasingly difficult for practices to get paid today due to regulatory conditions and increasing burdens on patients to pay “out of pocket” for services. In this business climate, it’s more essential than ever to tighten the ship and have clear visibility into both clinical and financial data. It takes more than a custom practice management configuration, and all the latest data to make sense of the practices’ cash flow and other essential data points that serve as indicators of population health. Identifying and implementing the appropriate programs, resources and tools can help today’s medical practices right the ship and thrive in a value-based payment world.

Implement a technology to help sniff out problem claims before they’re denied. By doing this your practice can identify hidden claims denial patterns and group them based on root causes. This helps you surface insights into why the claims were denied and to quickly address multiple charges as a group. By doing this in your practice you take the guesswork out of the appeals process, improve workflows, and reduce future denials before they occur.

Financial Reporting
It’s imperative that your practice generate comprehensive financial reports that can demonstrate the health of the business and reveal key areas for improvement. Key staff can use the reports to track every aspect of the practice’s revenue cycle. Also, don’t be afraid to ask your PM/EMR vendor about their advanced reporting options.

Quality Reporting
Make sure your practice “measures up” with these two Quality Reporting tools. The Centers for Medicare and Medicaid Services (CMS) actively incentivizes practices to meet new federal quality care standards. Starting with Meaningful Use, and now with the Quality Payment Program (QPP), CMS and participating clinicians are working together to promote effective, safe, efficient, patient-centered, equitable, and timely care. Be sure your PM/EMR vendor can support your quality improvement initiatives and provide the reports needed, so you can measure your progress in these key areas and receive the payment you’ve earned in the process.

Clinical Quality Reporting (CQR)
For most practices, demonstrating quality care is hard enough as it is. Work with your PM/EMR vendor to obtain the reporting tool for QPP attestation. These tools can help simplify reporting and capture your practice’s performance at the patient level. Further insight enables your practice to:
  • Visualize year-to-date progress toward program goals
  • View weekly measurement updates to help identify problem areas
  • More readily focus on the measures that need improvement
  • Link to individual patient records as proof points
Quality Submission Services (QSS)
Once you have successfully captured all the clinical data that CMS requires, work with your PM/EMR vendor to submit your individual provider or group practice quality data directly to CMS. These services reduce the administrative burden of quality data submissions and audits, making it easier to avoid payment adjustments for failing to submit data.

Although the transition from a fee-for-service to value-based payment delivery models has been slow, the healthcare landscape will continue to evolve, and physicians will adopt value-based care models in their practices.

Dan Gallagher is Vice President of Sales with Quatris Healthco. With over 17 years’ experience selling software to physicians, Dan Gallagher has produced solutions for a diverse array of medical practices — in both size and specialty.

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