Quality Over Quantity: What Value-Based Care Means For Providers

Quality Over Quantity: What Value-Based Care Means For Providers

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  QUALITY OVER QUANTITY  BY TXCIN WHAT VALUE-BASED CAREMEANS FOR PROVIDERS
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  The age ofvalue-based healthcare is here, and the Centers for Medicare and Medicaid Services (CMS) has taken the lead in healthcare delivery and reimbursement reform. The strategy is driven by a three-part aim to offer better quality health, to improve patient healthcare experiences, and to deliver services at lower costs.
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  QUALITY  In the transitionto value- based care, providers are challenged to operate in a state of payment duplicity, working in a declining, traditional fee-for-service (FFS) reimbursement model, while preparing for and participating in value- based contracts and payment models.  COMPENSATION
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  QUALITY  Quality and efficiencyare the goal of every value-based payment model, and CMS’s intention is to eventually transition every provider from fee-for-service to value-based care, linking provider quality performance to provider compensation. In this new strategy, an increasing amount of provider compensation is based on quality performance in areas of patient and caregiver experience, care coordination and patient safety, preventive health, and clinical care for at- risk populations. COMPENSATION
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  If the value-basedmethodology of quality-over-quantity is embraced, healthcare providers may experience greater freedom in how they practice, and they may see significant compensation as a reward for attaining and improving quality performance over time. http://www.insight-txcin.org/post/quality-over-quantity- what-value-based-care-means-for-providers
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  There are four conceptual“templates” for value-based care, and each consists of multiple models specific to specialty, episode, and patient population:
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  A V L Pay-for-Coordination: a primarycare physician leads and coordinates care between multiple providers and specialists to manage a unified care plan for patients and to ensure efficiency and quality; e.g., the Patient-centered Medical Homes (PCMH) model. Pay-for-Performance (P4P): healthcare providers are incentivized to meet certain quality and efficiency benchmark measures. Physician reimbursements are directly related to achieving these performance measures; e.g., the Hospital Readmission Reduction (HRR) program and the Skilled Nursing Facility Value-based Program (SNFVBP) U E
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  A B S Bundled Payment orEpisode-of-Care Payment: this model encourages quality and efficiency because healthcare providers are reimbursed with a set amount of money to pay for a specific episode of care, such as a hip replacement, and any complications. Providers keep any realized net savings; e.g., the newly launched Bundled Payments for Care Improvement—Advanced (BPCI--Advanced) model and the Comprehensive Care for Joint Replacement (CJR) model. Shared Savings Programs (one-sided and two-sided risk): physicians form entity groups and provide population health management. Quality and efficiency are achieved through coordinated, team care and any realized net savings are given back to the provider: e.g., Accountable Care Organizations (ACOs). E D
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  QUALITY  The value-based healthcare environmentis one of collaboration, a team mentality where providers are expected to work together to engage with patients, to provide care appropriate to each individual’s circumstances, and to align their efforts with multiple partner providers across the healthcare continuum. This strategic shift in quality healthcare is extremely beneficial to patient populations because it delivers a connected care experience where patients receive more coordinated, appropriate, and effective care.  COLLABORATION
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  THE ACO ROLE Accountable CareOrganizations (ACOs) are the premier example of collaboration within the value- based care strategy. ACOs are entity groups consisting of networks of physicians, specialists, surgeons, pharmacies, and hospitals who agree to coordinate care for a patient population, with the goal of improving quality care, while eliminating unnecessary spending. ACOs are instrumental in the long-term strategy of coordinating care to improve quality and value, and this collaborative approach is helping providers to realign their methodology to focus on value-based care rather than volume-based care.
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  Want More? http://www.insight- txcin.org/post/quality-over- quantity-what-value-based- care-means-for-providers
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  ABOUT TXCIN North Texas Clinically IntegratedNetwork, Inc. (dba TXCIN) is a non-profit ACO that began in late 2014. A small group of independent physicians aligned to initiate clinical integration and value- based contracting. Partnering with RevelationMD and its state-of-the art information platform, TXCIN has become the largest independent network of physicians in North Texas.