by Medical Advantage Group
November 6, 2018
Even with the best of intentions to improve patient care and outcomes, the health care system has become a complex web of technology, rules, operational processes, performance metrics, and reporting requirements that can be inconsistent and confusing for the health care delivery community. Health care providers, especially physician practices, need help to modernize their structures, processes, and technology to deliver care in a way that makes them successful in value-based arrangements.
Health plans have much at stake in this value-based care market, especially in government programs such as Medicare and Medicaid. There are millions of dollars on the table in the form of performance incentives, as well as the avoidance of penalties for health plans. Other motivating factors include reduced costs and improved health outcomes for members, higher CMS Five-Star Quality Rating System and NCQA accreditation rankings, increases in assigned membership, and the ability to offer a competitive price for employers and individual purchasers.
Despite these incentives, health plans find themselves largely dependent on physicians and other health care providers to deliver the results they desire. Forward-thinking health plans aiming to outpace their competitors and reap the rewards of value-based arrangements need to establish an approach that will provide hands-on help to physician practices. This requires relatively small yet targeted investments that will help practices modernize their daily operations and streamline care delivery guaranteed to create a positive return on investment.