Rasiga Elagovan

20 February 2024

Value-Based Care

2 Comments

Providers continue to expand their value-based contracts with payers, but this growth places administrative burdens on clinical teams that can be overwhelming, especially when it comes to documentation and referrals. To effectively meet the requirements of value-based care programs and prevent clinical burnout, healthcare organizations can greatly benefit from participating in risk adjustment programs. This program provides clinical teams with a list of patients with suspected risk status to help improve diagnosis and documentation at the point of care. At first glance, these projects may seem like financial issues. The primary goal is to advance risk capture to improve the accuracy of  ICD coding. This allows plans and providers to make risk-based payments more quickly and reduces the need for costly retrospective chart reviews. But the benefits to payers and providers go beyond cost. Virtually reliable provider-side predictive data can help clinical teams improve risk capture, care management, and operational efficiency. Letand examines six benefits of risk adjustment programs for providers and clinical teams.

1. Effectively removes treatment areas

Armed with relevant and actionable information about suspected conditions and patient recurrences, clinical staff can identify high-risk patients and conditions at the point of care. This validation allows providers to assess and manage patients and procedures, reducing gaps in care. 

2. Status doubt before the meeting

Private clinics have many facilities for new patients and patients receiving care from outside medical groups. Emergency situation information based on a wealth of clinical and claims data provides clinical staff with knowledge of patients and potential conditions, and helps providers identify what is most important to assess, treat and document at the point of care.

3. Improved compliance with preventive maintenance

With information about suspected conditions built into the point of care, providers are more likely to recommend preventive tests and other indications. This process provides preventive care services, helps identify potential upstream health issues, impacts compliance with HEDIS, STARS quality measures, and fosters ongoing care programs. 

4. Video maintenance management

Risk data helps clinical teams develop long-term medical records. After appropriate assessments are completed, providers can make evidence-based decisions about the type of care a patient should receive, including referral to a specialist, working with a case manager, enrolling in a training course, or additional support in Social Determinants of health SDoH). 

5. Better connectivity and usage management

The ability to better capture suspected conditions allows clinical teams to develop accurate and definitive diagnoses. Utilization management teams can use this benchmark as a reliable source to make better decisions about medical needs and improve responses to authorization requests. This is important to reduce attrition of service providers. 

6. Lower labor costs

Although risk management adds additional steps before, during and after the patient visit, these overheads reduce the workload for the clinical team. By providing accurate diagnostic information in the provider's workflow (which can be done at the point of care), post-hoc document gaps should be reduced and patient charts and monitoring areas should be eliminated for later risk programs reverse Reduce the wear and tear, time and cost of these administrative tasks and organize them. Finally, the growing number of value-based contracts places an administrative burden on clinical healthcare teams. To address these issues and prevent clinical burnout, participation in risk management programs is essential. In addition to the initial understanding of financial strategies, these projects aim to advance risk capture to improve the accuracy of ICD diagnosis. The benefits go beyond cost considerations, providing highly reliable predictive data to help clinical teams improve risk capture, improve care management practices, and optimize management efficiency. From closing gaps in effective care to reducing labor costs, the six benefits identified demonstrate the transformative impact of strategically integrating risk management programs to ensure a healthier and stronger environment.

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