How Electronic Health Payment Systems Advance Value-Based Care

How Electronic Health Payment Systems Advance Value Based CareA lack of clear and simple communications by payers with their providers on quality incentive initiatives may be hindering provider adoption of value-based care and reimbursement contracts. Seventy-four percent of physicians and healthcare executives who responded to a 2016 survey1 said that the complexity of quality measures makes it difficult for physicians to achieve them.

Value-based care reimbursement, which hinges on physician and clinical leadership buy-in, requires the processing of cumbersome and hard-to-understand quality contracts and metrics exchanges that do not clearly deliver insights into incentive progress. This challenge is even more difficult for the Centers for Medicaid and Medicare Services (CMS) and their health plans, which must communicate with their providers about Star Ratings.

Survey results also suggested that payer communications on quality measures for individual patients could enhance providers’ ability to achieve optimized patient outcomes. Seventy-nine percent of survey respondents agreed that physicians do not know the quality measures that pertain to individual patients.2

Another survey of physicians3 revealed that only one out of five physicians are familiar with the Medicare Access & CHIP Reauthorization Act of 2015, which created the Quality Payment Program, suggesting that 80% of physicians are not even aware that there are incentives available to them. Physicians may be missing out on the opportunity to earn additional revenue through incentives as well as improve patient outcomes.

Similar challenges exist for physicians and practices that have already taken steps toward value-based care. A 2017 survey of physicians engaged with value-based reimbursement4 revealed that physicians are achieving inconsistent results in terms of financial gain and quality improvement. Seventy-nine percent are planning to focus on developing financial competencies in value-based performance metrics in 2018 as a solution.

When they do, they will need help training and educating themselves and their staffs on the complex rules within value contracts. Without staff awareness and education, physicians will have a harder time closing care gaps and adhering to incentive guidelines because their staff members spend more time with patients than they do, and they process the paperwork.

It’s obvious that something needs to be done to improve and simplify communications between payers and providers with regards to upholding value contracts and also informing and educating physicians about the impact value-based care reimbursement can have on their patient outcomes and revenue.

Challenges Facing Payers

Payers undoubtedly feel daunted by this challenge and what is involved from a resource perspective with communicating to large numbers of providers that span from sophisticated integrated delivery networks to single doctor locations.  This diverse group of providers, regardless of size, are all strapped for time and resources, making the additional burden of quality measures hard to effectively incorporate into their care routines.

The challenge for payers is to identify an easy way to clearly and efficiently communicate quality measures that will impact care outcomes without having to build a new infrastructure to connect them with their providers. Not only would this undertaking be costly, but there would not be a guarantee that all providers would participate.

Beyond infrastructure, payers must also determine how to:

  • Create simplified and actionable messaging about incentives
  • Inform providers about care gaps in real time
  • Provide guidance on the quality measures needed to close care gaps
  • Track and report on providers’ status with care gaps and incentives

Easy Solution for a Complex Problem

Fortunately, there is a simple solution for those challenges.  Payers can simply leverage an existing network that already connects them with their providers. All they have to do is integrate a communications system with that network and with their providers’ financial hubs that they already access today for payments information.

Usually, the most direct and integrated existing system between a payer and provider is the electronic payment reimbursement system – making it a logical and easy-to-adapt pipeline for also communicating, delivering and exchanging quality incentives available to providers.

Providers in turn can share quality care information and attachments back to the payer in a bi-directional manner that satisfies HEDIS requirements. This includes simplified care gap notices, tracking reports and information about available incentives. Payers can easily share important information about programs with providers and receive documentation from providers.

It sounds complicated but it’s not. This two-way communication between the payer and provider does not require new systems or applications to be developed for either the payer or provider.

Getting started is easy.

Payspan has designed a Quality Incentive Communications System (QICS) that harnesses the Payspan network – the largest healthcare payment automation platform in the United States, connecting 1.3 million provider payees with more than 750 health plans who serve 110 million consumers.

Learn how Payspan’s QICS can help you.

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1-2Quest Diagnostics/Inovalon, “Finding a Path to Value-Based Care,” June 2016
3The Physicians Foundation, “2016 Survey of America’s Physicians,” 2016
4HealthLeaders Media, “Value-based Readiness: Setting the Right Pace,” May 2017