The US healthcare system spends more per citizen on healthcare than any other nation yet renders some of the worst patient health outcomes as reiterated by a January 2023 Issue Brief published by The Commonwealth Fund. As medicine and technology advanced in the US, the administrative and reimbursement support systems did not. This left our national healthcare system woefully behind with outdated practices and payment methodologies.
Value-based care seeks to reverse these trends by reimbursing healthcare provider organizations for wellness versus treating disease. Payment incentives prioritize quality outcomes over high-cost services and acute care admissions. And traditional fee-for-service models are replaced with at-risk, value-based contracts.
The evolution away from fee-for-service and toward value-based care has been underway for nearly five decades. The latest payment models have included such programs as the Pioneer and Next Generation Accountable Care Organization models, Bundled Payments for Care Improvement Initiative, and direct contracting. All these advancements present new opportunities for health information (HI) professionals to take on different roles, advance their careers, and optimize their healthcare experiences — and will continue to do so in the years ahead.
The Centers for Medicare and Medicaid Services (CMS) expects all traditional Medicare beneficiaries to be treated by a provider in a value-based care model by 2030. The CMS Innovation Center Refresh strategy from 2021 states:
- All Medicare fee-for-service beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.
- The vast majority of Medicaid beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.
Yes, these CMS goals for value-based care are lofty. But they are also attainable with strategic input and tactical support from HI professionals.
As the industry moves toward the CMS 2030 goals, it is vital that HI professionals secure a seat at the value-based care table to ease the transition while maximizing professional growth.
Three Factors Influencing the Future of Value-Based Care
Value-based care centers around the delivery of high-quality healthcare with a focus on patient outcomes, rather than the volume of services rendered. This approach emphasizes preventive care, care coordination, and evidence-based practices to enhance patient health and reduce unnecessary costs. By aligning incentives with desired outcomes, value-based care promotes more efficient and effective healthcare delivery.
Regulatory changes, data usability, and interoperability through advanced information technology (IT) all play a role in the transition to value-based care today and for the foreseeable future.
Healthcare regulations shape the implementation of value-based care, and provider organizations typically move quickly to reengineer workflows and meet new reimbursement model requirements. For example, CMS’s new Making Care Primary model will be tested in eight states starting in July 2024.
According to CMS, the new model provides additional revenue to build infrastructure, make primary care services more accessible, and improve care coordination with specialists. In response, primary care providers will most assuredly invest in IT, implement patient accessibility tools, and add care coordination staff to meet the program goals and achieve the revenue incentives.
HI professionals can assume leadership positions as new programs are announced and implemented. By becoming committee chairs, actively participating in policy development, and ensuring compliance with regulatory guidelines, HI professionals optimize their education and career know-how. Their expertise in regulatory compliance also prepares them to advocate for the effective use of health IT, electronic health records (EHRs), and other tools that promote interoperability and fulfill necessary quality reporting requirements.
Data drives reimbursement in most value-based care programs. HI professionals excel in establishing standardized processes that capture and report data for these programs. By applying core HI functions to meet data needs, professionals provide a strong foundation for the successful adoption of new value-based care models.
Beyond data capture and reporting, it is important to keep data usability, integrity, and security top of mind as health systems make the shift toward at-risk contracts. HI professionals enhance data integrity, quality, and usability through skills in coding and clinical documentation to ensure accuracy of diagnoses, procedures, and other patient information.
Interoperability and Health IT Know-how
Finally, reliable data governance frameworks and secure procedures for data access and management are essential as data exchange expands and interoperability matures. Interoperability is critical to quickly extract, aggregate, and share data, thereby informing more proactive healthcare decisions and timely population health management programs—two proven cornerstones of all successful value-based care initiatives.
Comprehensive understanding of IT systems, interoperability standards, and technology is a valuable asset to drive the implementation of value-based care programs. HI professionals should continually collaborate with their IT colleagues to assess the technology needs of healthcare organizations and align them with value-based care goals. Their ability to bridge the gap between IT and clinicians ensures that IT systems are used effectively to meet value-based care requirements.
For example, if the data isn't functional and not collected correctly (right data point in the right field), the output is inaccurate and unusable. This disconnect negatively impacts an organization’s ability to perform quality measures reporting, chronic care coordination, and member engagement.
By actively participating in the regulatory environment, enhancing data usability, and leveraging technology, HI professionals can drive successful implementation and make a lasting impact.
Your Seat at the Table Is Waiting
To capitalize on the career growth opportunities presented by value-based care, HI professionals must strive to secure a seat at the table. The following four steps can help:
- Seek involvement. Express interest to directors and VPs, advocating for involvement in value-based care initiatives. Actively participate in committees, task forces, and other relevant forums to contribute expertise and make a meaningful impact.
- Educate others. Educate leadership and stakeholders about the valuable skills you bring to the organization's journey toward value-based care. By highlighting the impact of HI skills on data integrity, compliance, and outcomes measurement, HI professionals gain recognition and support.
- Expand expertise. Stay educated and updated on the latest trends, regulations, and technologies in the field. Investing in professional development helps HI professionals remain at the forefront of the industry and position themselves for new and emerging roles.
- Think bigger. Think beyond traditional roles and consider how to leverage unique skills to enter new positions, or even create roles that do not yet exist. By embracing innovation and exploring untapped opportunities, HI professionals pioneer initiatives that drive the future of healthcare.
As healthcare evolves, health systems are challenged with meeting the needs of value-based care. HI professionals come alongside health systems and unlock their potential in this transformative era.
Angela Rose, MHA, RHIA, CHPS, FAHIMA, is vice president for client success at HI solutions provider MRO. She leads the implementation and account management teams, as well as MRO’s corporate policy.
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