Health care providers are under immense pressure coming from all directions in 2015. While the impact of the transition to ICD-10 is an immediate concern for many health care professionals today, there is another larger but less well-defined transformation looming in 2016 and beyond: the introduction of comprehensive care coordination models.
The transition from the existing Fee For Service (“FFS”) reimbursement model to new value based models is being driven by congress and the Affordable Care Act (“ACA”). The ACA is affording the nation opportunities to design and test new models of health care delivery to reduce spending and improve patient outcomes. Some of the new models being tested that you may be familiar with are Accountable Care Organizations (“ACOs”), Patient-Centered Medical Home (“PCMH”) and Medicaid health homes. All of these models aim to improve quality, safety, prevention, and coordination of care while benefiting the patient experience.
Providing coordinated care is not easy and is the responsibility of the care coordinator, who may be the patient’s primary care physician, a specialist, or someone specifically hired for this role. The care coordinator is the choreographer of an intricate dance between the patient and their network of service providers. Just as a good choreographer must understand the music and how it relates to each of the dancers, a good care coordinator needs to understand the patients’ needs and how they are best served by each provider or service.
In order to provide the best patient outcomes, a care coordinator will engage the patient, communicate a plan, assemble the team, and assist the patient in navigating their network of service providers. The care coordinator helps to ensure the best performances from their ‘dancers’ by making every improvement possible, giving each one the appropriate level of feedback, and facilitating communication in order to make sure that all of the details are taken care of.
One of the underlying principles of the ACA is that these new models of health care delivery cannot occur without payment reform. It’s easy to understand why. Models which reduce spending and improve patient outcomes are likely to result in reduced revenue for physicians as fewer unnecessary services are provided. Care coordination is also a cost to the provider which requires an investment in both personnel and infrastructure. If you add it all up, reduced income, increased expenses, and the fact that providers are not currently paid for providing care coordination results in a significant barrier to change.
So how does a choreographer recruit dancers to perform together? In order to attract providers, ACA is introducing payment reform by introducing financial incentives for providers to coordinate care. For example, within ACOs, providers get to keep a percentage of the savings generated by the ACO as long as they keep patients healthy. These incentives are being based on meaningful quality measures, such as Medicare’s PQRS measures which are not necessarily based on reducing expenditures but strengthening coordination of care.
The common theme of these value-based reimbursement models is to produce quality care that keeps patients healthy and at a reasonable cost. Accomplishing these goals requires a cultural shift toward patient-centric, collaborative care; a significant change in how patients and providers interact. This means enabling patients and providers to work together, and ensuring patients are receiving the care they need, in the right place, at the right time, by the right provider. Unfortunately, the necessary level of care coordination to create quality outcomes does not happen consistently through the existing FFS delivery model today. We need to improve.
pMD is looking ahead and actively developing new ways to facilitate care coordination. Through community based secure messaging technologies, enhanced PQRS capabilities, mobile charge capture, and our second-to-none integration expertise, we’re helping accelerate the transition to value-based care delivery (and making the dance more synchronized and fun!).