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Why a “Technology-Only” Approach Will Not Drive Value-Based Care Performance

By: Vatica Health

Over the last few years, we’ve witnessed significant advancements in medical technology including the proliferation of telehealth, remote patient monitoring, and artificial intelligence. These offer the potential to dramatically improve insights and shape healthcare delivery. While technology development is essential, it must properly interface with clinical services to drive the maximum benefit—for providers and for patients.

Recent technology developments that provide coding and care gap notifications in electronic medical records (EMRs) offer increased potential for value-based care. These solutions address an important problem—but are incomplete as they don’t ensure conditions are coded correctly. Patients must have their conditions accurately coded to ensure health plans and providers receive appropriate compensation. Accurate coding can lead to cost-effective clinical services with the goal of improving patient outcomes.

In reality, these “technology-only” solutions may compound the problem. Providers are inundated with competing priorities and lack resources to add additional uncompensated services—a situation exacerbated by COVID-19. Current solutions cause alert fatigue and have little impact on care. They also suggest insights based on unsubstantiated data and therefore create compliance risk.

Value-based care requires a comprehensive solution
The transition to value-based care is inevitable. By 2025, it is anticipated that all Medicare Advantage and traditional Medicare plans will adopt two-sided risk alternative payment models. Fifty percent of Medicaid and commercial plans will adopt these models. This move requires providers to accurately code services for appropriate risk-adjusted reimbursement, connecting financial performance and quality of care. Success in value-based care depends on accurately assessing patient needs so that provider payments—based on the reported health conditions for that patient-- will be sufficient to deliver appropriate care.

Technology cannot replace providers and clinical judgement. To drive optimal performance in value-based care, consider leveraging powerful, clinically validated technology coupled with clinical experts. By using technology combined with clinical experts, care gaps and relevant diagnostic codes can be identified. Such comprehensive services lead to more accurate coding and better performance in value-based care for both providers and health plans.

Evaluating possible solutions
There are a growing number of solutions that promise to drive value-based care performance, but very few that provide a comprehensive approach to improving risk adjustment coding and quality of care. Here are three questions to consider when evaluating various solutions:
  1. Is the risk adjustment and quality solution provider-centric? Providers need intuitive, easy-to-learn, and simple-to-use technology that seamlessly fits into their workflow, uses their EMR and intelligently mines data to optimize efficiency.
  2. Does the solution provide comprehensive in-office support? In addition to data and technology, providers need access to onsite clinicians who understand the technology and serve as an extension of their team at no cost to the practice. These clinicians can perform various tasks to reduce the burden on providers and their staff.
  3. Does the solution ensure coding accuracy and compliance? While there are “technology-only” solutions that surface codes in providers’ EMRs, they are often derived from unreliable data sources and not validated by certified clinical coders. This creates audit and compliance risk.  

New Guidance for Reducing Health Care Organizations’ Carbon Emissions

By: Melissa Suran, PhD, MSJ

Through the Agency for Healthcare Research and Quality (AHRQ), the US Department of Health and Human Services (HHS) released a primer to help health care organizations cut their carbon footprints. Reducing Healthcare Carbon Emissions: A Primer on Measures and Actions for Healthcare Organizations to Mitigate Climate Change is now available online.

An AHRQ statement noted that the health care industry substantially contributes to climate change, even though it’s also responsible for mitigating its harmful health effects. The researchers of a 2020 study in Health Affairs estimated that the health care industry produces 4.4% to 4.6% of global greenhouse gas emissions.

The AHRQ’s primer, developed through a contract with the Institute for Healthcare Improvement, aligns with a federal goal of decreasing greenhouse gas emissions by at least 50% of 2005 levels by 2030 and moving to operations with net-zero carbon dioxide emissions by 2050. According to the primer’s call to action, 61 of the largest US hospital and health sector companies have already agreed to this goal.

The primer covers areas in the health care industry that contribute to emissions, including anesthetic gas, energy use, food procurement, transportation, medical devices and supplies, and pharmaceuticals and chemicals. It also mentions some consequences of climate change, which exacerbate inequities by particularly affecting historically marginalized communities.

“Extreme weather events, declining air quality, and growing food and water insecurity now threaten healthcare operations and present challenges in care continuity, patient safety and quality, and cost containment,” AHRQ Director Robert Valdez, PhD, MHSA, said in his agency’s statement. “Healthcare organizations must develop approaches to care that meet the climate health needs of disproportionately affected communities and rapidly reduce their contributions to environmental emissions.”

Join PA MGMA for exclusive access to the Washington Connection issued by National MGMA!

December 2022

Letter from the board chair

As the year quickly comes to a close, I want to take this time to thank everyone for their support and effort on behalf of the Pennsylvania MGMA.

In 2023, I invite you to participate in our programs, network with colleagues and peers from across the state, and engage with one another as we face new and different challenges and opportunities.

In addition to evening networking events, our 2023 program schedule includes a virtual Payor Day event with payors from across the state, regional Practice Management Forums with focused discussion, and a practice management workshop.

But, that's not all! We're meeting in-person at our annual Healthcare Leaders Summit on Tuesday/Wednesday, April 25-26, 2023, at the DoubleTree Resort in Lancaster. Our Summit begins with lunch on Tuesday followed by our first keynote presentation by the incredible Tracy Spears! Her dynamic session will be followed by breakout sessions, the opening of our Exhibit Hall, and an evening Welcome Reception with drinks and appetizers.

On Wednesday, we will have a second keynote presenter [to be announced in January], multiple breakout sessions, the exhibit hall, and much more. Save the dates - April 25 & 26, 2023!

There is a lot happening in 2023 with the Pennsylvania MGMA. Take advantage of all we have to offer for you and your practice.

May you and your family have a safe and happy holiday. May the New Year bring good health and success.

Shelley Rine, CPC, COPC

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