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Managing Risk in Complex Value-Based Care Models

comprehensive MIPS solution

Understanding the complexity of financial risk involved with value-based reimbursement programs is a challenge. As value-based care reimbursement models have evolved, so too has the financial risk. Performance thresholds are moving higher and the sheer number of elements involved make it challenging to manage what’s needed to perform effectively under these contracts.

An important resource that is easily overlooked, is having staff devoted to analyzing performance across all value-based programs.

At HFMA’s Annual Conference, Jennifer Carney, vice president of finance and analytics for Beth Israel Lahey Health Performance Network noted: “The need for resources is paramount and ongoing. For us, key resources are both clinical and IT related. On the IT and analytical side, you need data-integration folks who can bring the information together to support efforts to achieve targeted outcomes, especially in a system like ours where we’re not on one electronic health record.”

To be successful under value-based care, an organization should have as its primary goal the ability to provide transparency and accurate information that allows physicians to make informed decisions and know what levers to pull to impact quality scores and reimbursements.

Beginning in 2022, the performance threshold in the MIPS program will be set at the median of the final scores for all Eligible Clinicians from the prior reporting period. This means that roughly 50% of practices will fall below threshold and may suffer a penalty.

Success in this shifting reimbursement landscape requires a comprehensive solution that provides directly actionable clinical insight. Without a plan in place to get ahead of the moving threshold target, some practices will bear the burden of downward payment adjustments.

At ReportingMD, our team and our technology integrate seamlessly with yours to help close information gaps and provide clear and accurate analysis of clinical performance across all risk models. We partner within each level of an organization to help you manage value-based risk smoothly, with less administrative burden and no disruption to the delivery of care.

With more then 18-years’ experience in value-based health care, we are uniquely positioned to help.

  • Optimize quality scores
  • Reduce physician, IT and administrative burden
  • Enhance performance incentives and reimbursement
  • Improve patient outcomes through care-gap management

Waiting until 2022 has begun, or even procrastinating further into the 2021 performance year will likely result in poor scores, minimal incentive, or even penalties for years down the line. Now is the time to establish a forward-looking plan for success in value-based care.

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