Using Your EHR to Optimize Performance in a Value-Based World
Written by: Cheryl Reifsnyder, PhD
Value-based care, or care that incentivizes providers based on quality of care and improved patient outcomes, is becoming an increasingly common reimbursement model in U.S. healthcare. The U.S. government has been working to steer healthcare systems toward the value-based care model for over a decade. The Centers for Medicare and Medicaid Services (CMS) is the largest payer of healthcare services in the U.S. and, as such, is also the primary driver of incorporating the value-based payment model. Recently, CMS announced plans to incentivize provider participation during the transition to value-based care. They also predict that all Parts A and B Medicare beneficiaries and most Medicaid beneficiaries will utilize value-based care models by the end of the decade.
Value-based care promises numerous benefits for both patients and providers. Value-based care models have the potential to both improve patient care and reduce healthcare inefficiencies; at the same time, the changes to practice culture prompted by changing to a value-based model can lead to improved staff morale. However, there is also risk in value-based care. Value-based care programs provide reimbursement based on improving patient access to quality care and achieving better patient outcomes—but the cost of that care can vary widely depending on the health of the patient involved. That’s where risk adjustment comes in: A process to help ensure providers receive appropriate compensation for treating patients—even high-risk patients.
Risk adjustment enables providers to balance the higher cost of care required by some patients based on the health conditions that increase their overall risk. However, capturing patients’ risk factors requires assembly of a complete and accurate picture of each patient’s health. This can be challenging, as essential details are often hidden in the unstructured text fields in patients’ electronic health records (EHRs). Traditionally, health systems have relied on labor-intensive manual chart reviews to accurately determine patients’ risk and determine the proper compensation. As a result, many providers are hesitant to invest in the time and solutions required to adequately manage value-based activities.
However, there’s a better way to track patients’ risk profiles and a better way to adopt the tenets of value-based care. In this article, we look at Veradigm’s suite of ambulatory solutions for monitoring—and enhancing—progress toward quality initiatives while simultaneously optimizing patient care.
Veradigm EHR contributes to improved patient outcomes
Veradigm EHR is an ambulatory EHR platform that supports the needs of provider practices as they transition to a value-based care model. One of the primary ways Veradigm EHR supports value-based care is by improving patient outcomes.
Grants providers access to complete and accurate patient information
Supplying clinicians with complete, accurate patient records at the point of care is critical to providing quality patient care and improving patient outcomes. It helps ensure nothing gets missed, reducing errors and improving patient safety—one of the core elements of value-based care. Access to complete patient information also improves healthcare providers’ (HCP) ability to diagnose diseases and chronic conditions.
A national survey of HCPs showed:
- 88% of physicians reported that EHRs provided clinical benefits for their patients
- 75% reported that EHRs allowed them to provide better patient care
One reason is that EHRs can provide a broader view of a patient’s medical history than paper records. For example, Veradigm EHR enables providers to track patients’ health data over time using Flowsheets, making it easier to monitor progress and identify gaps in care.
Facilitates preventive care
One major target of value-based care is an increased focus on prevention-based services, such as diagnostic screenings. Value-based care contracts frequently include payment structures centered on offering proactive, preventive patient care. Veradigm EHR can facilitate this prevention-based focus by providing alerts for preventive screenings and delivery of preventive care.
By facilitating prevention-based services, Veradigm EHR can help decrease the overall cost of patient care by reducing patients’ need for future medical services—supporting another tenet of value-based care: efficiency.
Improves communication among care team members
Veradigm EHR also supports value-based care by making it easier to share patient data with other providers, improving coordination of care. It enables integration of primary, specialty, and acute care, allowing HCPs to work as a networked team to deliver the best-coordinated care possible. By facilitating communication among providers, Veradigm EHR also reduces redundancies in care, making care more efficient.
Physicians participating in Medicare’s Merit-based Incentive Payment System (MIPS) are required to report care coordination data, which is used to help calculate their annual MIPS scores. These are used to determine payment adjustments applied to Medicare Part B reimbursements.
Veradigm EHR provides integrated risk adjustment tools
Another way Veradigm EHR supports value-based care is by providing integrated tools for risk adjustment—tools built directly into the product, not as a separate add-on. Risk adjustment tools are essential in the value-based care landscape, where they can help providers ID high-risk patients in need of costly medical interventions. Early identification enables healthcare organizations to provide targeted interventions that can help prevent complications, reduce hospital readmissions, and improve patient outcomes.
Veradigm EHR provides predefined risk management programs as well as the option to create customized programs. The predefined risk management programs include:1
- The American Academy of Family Physicians (AAFP) risk management program
- Pregnancy Type program, used to track patient’s pregnancy as high-risk or normal
- The risk-scored Risk Adjustment Program created by CMS, which uses numeric values to indicate whether risk scores are Low, Medium, or High1,2
- SITE RISK, a foundation program available for practices to customize to their particular risk categorization needs
The custom risk-stratified care management programs and score programs allow your practice to define risk levels for customized programs, such as a program focused on a specific diagnosis. For both predefined and custom risk management programs, it is possible to apply programs and assign risk levels to individual patients or multiple patients simultaneously.1,2
Veradigm EHR provides annual or bi-annual HCC alerts
Veradigm EHR provides another key tool to assist with risk management: It provides hierarchical condition category (HCC) alerts on an annual or bi-annual basis to remind providers to document HCC-weighted chronic conditions during face-to-face patient encounters. Providers can also add HCC diagnoses to a patient encounter on the Search tab in Assessment/Plan, then review all HCC diagnoses for that patient on the Risk Score tab.3
The Risk Score tab displays the patient’s current risk score as well as all HCC diagnoses. HCC diagnoses include those that are assessed, which count toward the patient’s current risk score, and those that are unassessed, so do not count toward their current risk score. Each HCC diagnosis has a specific risk adjustment factor (RAF) weight, which is used to update a patient’s risk score in real time when:3
- A new HCC diagnosis is added to the patient encounter, or
- An unassessed HCC diagnosis is assessed in the patient encounter
The Risk Score tab displays the patient’s current risk score, as well as the total RAF weight of unassessed diagnoses if there are unassessed conditions for the patient.3
Helping you succeed in a value-based world
Veradigm EHR and its suite of ambulatory solutions are built for both clinical and financial performance. They enable providers and practices to monitor progress toward quality initiatives and help them make the adjustments needed to improve revenue while streamlining the patient care process. At the same time, Veradigm EHR provides updates to enable success in a constantly evolving regulatory landscape.
The combination of tools for facilitating patient care, enhancing provider communication, and calculating and tracking patients’ risk scores create a powerful assist as you transition to value-based care. Contact us to learn more or to schedule a demonstration of how Veradigm EHR could help meet your practice’s unique needs.
References:
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Veradigm. Using risk-based care management programs to flag patient charts. September 19, 2022.
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Veradigm. Risk Adjustment programs. July 19, 2021.
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Veradigm. Add and review HCC Diagnoses in Assessment/Plan. May 13, 2022.