Maximize Profitability and Increase Quality Outcomes in a Value-based Reimbursement Model
Population Health Management Is Powered by Healthcare Analytics
The complexity of a hospital or healthcare network's adoption of a value-based reimbursement model based on population health management can't be overstated. The amount of cost, clinical, and operational data and analysis needed is increased exponentially for both running day-to-day operations and evaluating overall contract profitability.
population health management depends so heavily on data, the guidance provided by healthcare data analytics is a requirement for success.
Value-based Reimbursement and the True Cost of Care
In order to succeed with value-based reimbursement, organizations need to be able to evaluate contract profitably at the population level while also understanding the impact of the individual patients that make up the population. At the end of the day, how does the total cost of care across the population relate to what the network was paid? How can this ratio be improved?
In many cases, existing claims can begin to unravel the total cost of patient care. A good starting point, but their limitations quickly become apparent. For example, claims can tell you the number of patients who received hip replacements over a given time, but don't provide detail into the specifics of care such as whether or not medications were dispensed within recommended time windows. Additionally, the impact and cost of subsequent ambulatory and out-of-network services is not likely to be reflected in these claims.
Healthcare data analytics helps you make the most out of value-based reimbursement by bringing data together to close information gaps and create a "big picture" of the cost of care across the entire continuum. In order to do this, analyses that take into account claims, clinical data, lab results, operating room data, non-acute treatments, and more are necessary. Healthcare data analysis helps physicians understand the impact of their healthcare decisions on cost and profitability, opposed to what was actually paid.
Meeting—and Beating—Quality Benchmarks
The Centers for Medicare and Medicaid Services (CMS) uses a variety of quality indicators to determine the value-based reimbursement a hospital will receive for treating its patients. Hospitals that exceed performance benchmarks relative to peers receive a higher percentage of compensation.
Take advantage of robust
health data visualization tools to help reveal opportunities for improvements in quality that will ultimately result in improvements in pay.
Next: Peer Benchmarking and
Healthcare Performance Improvement