As more providers pivot to and embrace value-based care, their foremost concern is delivering the highest quality service to patients while using available resources appropriately. But they also have another priority that stays top of mind: ensuring their financial solvency under a new care model. Financial success requires a multi-faceted strategy, and accurate coding of services is a vital component. However, providers can’t protect their bottom line alone. They need help. Risk adjustment coders partner with practices to help them understand the importance of correctly using condition codes to estimate patients’ future healthcare costs. Hierarchical condition category (HCC) coding is
In value-based care, the reporting of data drives all decisions and actions. When practices do not have sufficient reporting material, or they do not fully leverage the analytical tools they have, they quickly learn what a challenge it can be to keep patients healthy and drive success in a value-based model. Reportable and actionable data management can be a challenge to many private practices. It consumes a lot of time and administrative resources to collect and analyze data so that providers can make informed healthcare decisions. Without back-end support to manage data, practices often fall behind, which leads to negative
Value-based care has a clear goal: to provide the highest-quality, most equitable patient care while controlling costs. As a growing number of hospitals and healthcare systems gravitate toward this care model, utilization management (UM) has emerged as a fundamental component to successful implementation. Doctors are well equipped to identify the services a patient needs, but they need a partner who can ensure patients receive those services in the right setting for the optimal price. This is where UM nurses step in to be that collaborator. UM nurses serve as a liaison between providers and payers. They review patient clinical records
More providers than ever are expected to enter value-based care (VBC) over the next several years, thanks in large part to the Centers for Medicare & Medicaid Services’ (CMS) goal that nearly all Medicare beneficiaries will be treated by a physician in a value-based model by 2030. VBC rewards providers with incentive payments for quality of care, meaning compensation is linked to performance on predetermined quality and cost metrics. The healthier they keep their populations and drive down the cost of care, the greater their potential incentives. This is exciting for the future of medicine, but it also presents some challenges.
Doctors don’t have much time with each patient, so they need to make the most productive use of that time. This makes smooth and seamless workflows in medical offices a must. Pre-visit planning (or chart prep) is a useful technique that helps create efficiencies within practices.
The healthcare system can be complex and confusing. Many patients need an advocate—a case manager—who can help them get the care they need.
In value-based care, it takes a village of professionals to ensure patients are well cared for and practices meet benchmarks. Community health workers are emerging as key players in helping to achieve these goals.
The emergency department is often a patient’s first thought for acute care. But it often isn’t the best option. Doctors can empower patients to choose better, alternative care settings using the tactics discussed here,
Seasonal scheduling is a way for physicians offices to adjust their schedules to make room for wellness exams during specific times of the year. Learn how to leverage this practice to increase patient satisfaction and quality outcomes.