Solutions to value-based care obstacles

Solutions to value-based care obstacles April 23, 2018

For independent physicians, following the changing regulations for reporting value-based care can be a significant challenge. The Centers for Medicare & Medicaid Services (CMS) has shifted its focus between programs and, in fact, is seriously considering scrapping the Merit Based Incentive Payment System (MIPS) that has been at the center of its value-based trend.

Providing value-based care continues to be, in its essence, an important part of a primary care physician’s daily practice. Quality of care is more critical to the patient than quantity of visits. However, there are many obstacles to providing and reporting that value-based care, beyond the CMS uncertainties.

Some of those value-based care obstacles – and their solutions – include:

Patient engagement. The ability to engage patients in their own healthcare is critical to the quality level of their care. Communication with patients on their follow-up plan, clarifying instructions and answering post-visit questions, can increase that engagement. Additionally, arranging “regular discussions with a care manager who really ‘knows’ their conditions and concerns helps to establish trust and engagement that will deliver ongoing benefits in terms of both patient satisfaction and physician insights.”

Effective care management for “super utilizers.” Independent primary care physicians are often faced with the challenge of patients who need to be seen multiple times for complex conditions. Some research points to extraordinary usage figures: “80 percent of healthcare costs are driven by 20 percent of patients and … 50 percent of costs are incurred by just 5 percent of patients, aka Super-Utilizers. Among Medicare fee-for-service (FFS) beneficiaries, people with multiple chronic conditions account for 93 percent of Medicare spending.” Behavioral Health Integration Services (BHI), and Chronic Care Management (CCM), both CMS programs, offer mechanisms for the primary care physician to more effectively manage the care of patients with chronic conditions.

Access to sufficient comprehensive information. Coordinating care with specialty providers and having easy access to information from laboratories and healthcare facilities is a necessity for quality value-based care. An integrated, coordinated electronic health record (EHR) system offers independent physicians the ability to do just that. Specifically, interoperable EHRs allow the electronic sharing of patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients and patients can move in and out of different care facilities.