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Is a Lack of Analytic Resources Slowing Your Transition to Value-Based Care?

The little-known consequences of the 2021 ACO rules

Is a lack of analytic resources slowing your transition to value-based care?

Medical groups find that value-based contracts are responsible for an increasing share of their revenue. As these programs mature, we see further evolution on both the public and private payer side. Value-based contracts are expected to account for more than 60 percent of all healthcare payments by the end of 2021.

In order to thrive in this changing reimbursement landscape, organizations should examine the resources necessary to support physicians and the financial objectives of the organization.

Providers are always eager to improve clinical outcomes. However, the sheer volume of data involved with juggling “outcomes” across multiple contracts makes it difficult to understand what’s needed to perform effectively.

Practices need the right resources on the analytics side to understand all the components of each value-based contract, which are the important clinical levers and where opportunities exist to drive performance.

Those analytic resources should have, as their primary goals, the ability to provide clear and accurate information that allows physicians to make informed decisions and allows administrators to track and document performance.

Leveraging technology in the right way can lead to operational improvements and efficiencies that allow healthcare organizations to actively manage each step of the patient experience.

Clinical Performance Data

Accurate performance data is essential to success with any value-based contract. Some payer’s make information available, which is entirely based on claims. While this is helpful, it’s critical to understand the data upon which the payer is measuring performance.

While claims data is helpful and directionally informative, claims-based data is only half of the story and does not paint a clear picture of the patient experience.

Combining clinical, claims, social and other data into a single platform can transform how groups are analyzing performance. Providing a 360-degree view of the patient experience is essential to making this transition effectively.

Quality measures

Pay-for-performance agreements often document the specifics of measure development and the calculation and determination of measure performance.

Some payers use their own measures but base them on their own interpretation of nationally accepted measure sets. These benchmarks, met/not-met criteria, triggers and qualifying events can vary from plan-to-plan and are different from those CMS uses in its programs.

Success in these arrangements requires that you have a solution in place so that you can measure and monitor your performance in each program and for every eligible clinical event.

Actionable Information

Having the tools to exceed the clinical-quality measures used by each plan or contract is obviously critical to success with these programs. But be cautious not to overlook the larger picture view of how analytic tools dovetail with population health and care coordination initiatives.

Finely tuned practices will actively leverage data to help close gaps in care and manage at-risk populations – while tuning their clinical behaviors to achieve the most restrictive of contracted measures.

At ReportingMD, we offer solutions that help groups thrive in value-based care.

ReportingMD analytic solutions provide visibility into quality performance benchmarks and way points. We help mitigate the risk in these programs by bridging the information gap and providing the operational visibility necessary to analyze performance and uncover critical insights.

Merging clinical and claims data into a single dashboard, ReportingMD solutions are built on rock-solid technology. With the power to manage multiple TINs and drill-down to the individual patient encounter, this powerful tool provides near-real-time insight.

Our clients engage ReportingMD technology to manage disparate data sources and combine them with analytic tools that drive actionable clinical insight.

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