Health insurers of all stripes are moving toward value-based payments that can include higher reimbursements for providers demonstrating an improved level of quality. And electronic health records systems hold the key to improving quality and demonstrating its achievement.
“Quality-based payments have the potential to create a sea change previously not seen in the healthcare industry,” said Rene Cabral-Daniels, CEO at Community Care Network of Virginia, a series of federally qualified community health centers treating underserved populations.
The nation’s community health centers are taking advantage of value-based payments to be able to continue caring for the most vulnerable patients. Community health centers are more likely to treat patients with chronic illnesses, including depression, diabetes, asthma and hypertension, among other issues, she said during a session at the HIMSS16 Business of Healthcare Symposium.
“The care at community health centers meets or often exceeds national standards,” she said. “We have familiarity with this population and generate savings via preventive care management.” Overall, this network of health centers saves more than $24 billion to the healthcare industry a year, she estimated.
The data to demonstrate increased quality is in providers’ electronic health records system, Cabral-Daniels noted. By reporting improved quality measures, community health centers can significantly increase their payments, as much as $15,000 more per center just from the Health Resources and Services Administration, she said.
Further, additional compensation for physicians based on meeting quality metrics is a strong incentive not just financially, but because physicians are a competitive bunch, she added.
Too often, providers are leaving money on the table that healthcare insurers are willing to pay, Cabral-Daniels said. The Virginia community health centers, which get quality metrics data from each health plan they work with, collects about 100 quality measures that determine not only high performers but those who need help, and data from the measures also informs how to tailor educational courses that can help improve their performance. The data further is used to demonstrate comprehensive use of the EHR, which further enriched Community Care Network of Virginia by $9 million in 2015.
Register or login for access to this item and much more
All Health Data Management content is archived after seven days.
Community members receive:
- All recent and archived articles
- Conference offers and updates
- A full menu of enewsletter options
- Web seminars, white papers, ebooks
Already have an account? Log In
Don't have an account? Register for Free Unlimited Access