Many healthcare organizations will be shifting from fee-for-service to value-based care this 2014. Value-based care, which encompasses accountable care, population health and financial incentives, is said to be the upcoming standard for healthcare delivery and reimbursement this year.
The healthcare BPO is a “hidden jewel” for the Philippines’ global services industry. Lumeris, an accountable care innovation company, offers five predictions for value-based care this 2014:
1. Healthcare spending will increase if we fail to manage high-risk patients and events.
Care management programs will be important to reduce healthcare spending. According to Lumeris, “without Care Management programs, the industry will struggle to provide better quality care at a lower cost for people with multiple health and social needs.”
In order to achieve better care at lower cost, health systems need to change the way they manage high-risk patients and create an entire care community that works together to ensure each patient receives the right care, in the right place, at the right time.
2. EMR technology alone is insufficient for population health management.
Electronic Medical Records (EMR) are valuable in gathering data on quality and patient information. Without widespread EMR adoption and tools, clinical information at the patient and population level is not available in a usable format. Without the proper incentive to use tools and information, physicians will slowly learn the stages of its meaningful use, and the industry will never fully realize the quality improvement and cost-saving promises of technology. Providers need readable format to fully realize the cost-saving and quality-improve potential of EMR technology.
3. Physician burnout will increase unless we get providers off the hamster wheel.
A recent study found that nearly half physicians are experiencing symptoms of burnout. Value-based care models, however, may lessen burnout by allowing physicians to focus on patient care and outcomes.
Tom Doerr, MD, Lumeris’ Director of Innovation Research and a primary care physician, predicts that once physicians restructure their practices for value-based care and are given the incentives, tools, and information to manage their patients and populations, they will find satisfaction in their work and avoid burnout.
4. Payers and their network of providers will assume greater risk under the Affordable Care Act.
Payers who are offering plans through the health insurance exchanges, as well as the providers contracted with these plans, face greater risk because little information is available on enrollees and their health status.
“Managing risk in the marketplace requires a proactive and prospective approach,” said Terri Bellmore, Lumeris’ Director of Accountable Care Consulting Services. “As health plans and providers assume risk for this population, they need to prospectively assess a patient’s health status, and then properly document and code the conditions in order to manage risk and receive optimal reimbursement.”
5. The impossible task of leveraging big data will be possible with interfacing.
Lumeris Vice President of Technical Solutions, Keith Blankenship predicts that in 2014, interfacing will make it possible for health systems, hospitals and provider groups to more cost-effectively and quickly extract data from hundreds of different EMR and Practice Management Systems without disrupting practice operations or patient care.
Philippine Health Care Information Management (HIM) is patterned largely on US models thus these predictions will help the Healthcare BPO to respond appropriately to the demands and standards of its clienteles.