It’s no secret that today’s healthcare landscape is changing. As costs rise and reimbursement models change, healthcare organizations are continuing to track towards value instead of volume. With this transition comes the rising importance of quality, especially since payers and providers are now dependent on quality measures for reimbursement. According to CMS, these measures are meant to quantify healthcare processes, outcomes, patient perceptions and organizations’ structure associated with providing high-quality care. This journey requires a shift in mindset and new approaches to sharing information to enable quality improvements.
The first step in improving quality of care is the collaboration between payers and providers. Bruce Carver, associate vice president of payer services at MedeAnalytics, notes the importance of this collaboration in a recent interview with Becker’s Hospital Review, explaining that there are great opportunities between payers and providers, especially around data and best practices, to enhance value-based care, such as eliminating gaps in care and driving positive outcomes.
The second step is to use data as a guide to outline areas of opportunities. As payers and providers adopt technologies that enable value-based care, forward thinking organizations are collaborating on quality management programs that serve as the basis of their efforts. These programs must be designed to not only measure and monitor quality measures, but also lead data-driven conversations so payers and providers can collaboratively improve clinical outcomes for their patient populations. Through collaboration and the power of data, both payers and providers can leverage valuable information in the following ways:
- To measure and record an organization’s performance – Both payers and providers can benefit from understanding where their organization is succeeding in providing their members and patients with quality care. Among the many measures, HEDIS and CMS Star Ratings have the greatest impact as value-based care unfolds.
- To help avoid duplicative care – Today’s disconnected provider environment means that many providers operate in silos and do not have insight into care performed by other providers. Duplicative care is not only a waste of time for the patient, but it also negatively affects the healthcare organizations’ bottom line. By taking a holistic approach to a data strategy, organizations can better work together to avoid this.
- To better identify high-risk patients – Data, combined with population health tools and predictive analytics can identify high-risk patients immediately instead of waiting months for data to be generated. Identifying these types of patients early can allow organizations to step in to create personalized, automated interventions that lower healthcare costs and improve the overall health of the patient.
As healthcare industry continues to evolve, payers and providers must look toward a future defined by positive outcomes for their patient populations. The focus on quality and value will become more deeply ingrained. To meet these objectives, organizations must collaboratively design programs that enable them to meet or exceed quality measures and pay-for-performance expectations—today and for years to come.
To learn more about how to improve quality of care for your members in today’s changing healthcare ecosystem, access our whitepaper, Enabling Payer and Provider Collaboration in the Journey Toward Quality Care. To learn how MedeAnalytics can help you on this journey, learn about our quality management solution here.
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