In recent years, the healthcare industry has undergone a significant transformation, pivoting from traditional fee-for-service models to more sustainable Value-Based Care (VBC) models. This shift is driven by a mandate from the Centers for Medicare & Medicaid Services (CMS), pushing for all providers, to embrace some level of downside financial risk by 2025. This approaching deadline marks a pivotal moment, emphasizing VBC as both a financial and ethical imperative.
At the heart of this VBC transition are the increasingly common Pay-for-Performance (P4P) contracts, designed to incentivize healthcare providers to improve the quality and efficiency of patient care.
P4P scores are derived from a variety of metrics designed to assess the quality of care provided by healthcare professionals and institutions on a 4-point scale. These metrics typically include patient outcomes, adherence to clinical guidelines, patient satisfaction, and efficiency of care delivery. The scoring process involves a comprehensive review of clinical data, patient feedback, and operational efficiency indicators. Higher scores indicate better performance and are therefore rewarded with increased reimbursements and financial incentives while lower scores may result in reduced payments and financial penalties.
While the adoption of P4P programs is a critical step toward the broader implementation of Value-Based Care models, the thought of reduced payments and penalties can be very intimidating particularly for smaller organizations focused on survival.
“What if we’re not quite ready to embrace a VBC model”
For some, uprooting familiar processes for a risk-based VBC model may seem daunting, especially in areas such as rural health where resources tend to be a bit more scarce and survival is the main concern. However, when done well this transition can not only be quite lucrative but it can ensure patients are seeing improved outcomes and high quality care.
The question is... How can you take the leap and feel truly confident in our success?
Caret Health has recently come forward with a solution designed specifically for rural health. Their program analyzes & prioritizes opportunities to reduce costs & increase quality. Caret takes a hand-on approach to care management by implementing a centralized team to do the heavy lifting for you. Almost unbelievably, this means getting results with little to no resource drain, burden, or workflow changes (evidence in the results below). Their customizable technology is designed to meet each organization at the their level which means they can help you improve quality measures to ensure gap closure, improved outcomes and financial stability whether you are in a VBC agreement, just starting the transition, or not quite ready to make the leap.
Despite the clear benefits of P4P programs, healthcare providers face several challenges in achieving high scores. These challenges include:
Data Collection and Reporting: Caret boosts robust data collection and reporting to accurately track performance metrics. They take it further by having their centralized team create & perform custom workflows to drive results around highly weighted measures.
Patient Engagement: Caret boosts patient engagement with remote intervention techniques equipped to help patients manage chronic conditions and adhere to treatment plans. In addition to offering bilingual services Caret has built a strong track record of working with & boosting engagement among high-risk Medicaid and Medicare Patients. The program can also address SDOH.
Staff/Physician Burden & Resource Constraints Caret's highly trained centralized team consolidates tasks and then does the work for you. Physician's are provided escalations and monthly reports to help them stay aware and ahead of care.
In a recently released study from Caret Health, we witness how significant these challenges can be for providers striving to meet these new standards without concerted efforts. Caret launched a 1 year quality program in Apple Valley California where 3 of 3 provider practices were marked with extremely low or failing quality scores. Caret customized the program to each practice's unique needs using their prospective intervention approach. Increases as high as 653% for quality and an 853% in adjusted PMPM in just 1 year were witnessed.
Results indicate Caret Health’s ability to transcend traditional passive data programs by empowering a low-cost centralized team with a hands-on prospective intervention approach that efficiently engages challenging high-risk high-cost patient populations to achieve significantly improved value based care outcomes. Contributing factors include notable improvements in high blood pressure control, cancer screenings, and diabetes care.
See Detailed Results below.
As the industry continues to evolve, the focus on value and patient outcomes will undoubtedly lead to a more efficient, effective, and equitable healthcare system. Making investments in technology by partnering with programs that take a more hands on proactive approach to data will inevitably drive a smoother and more successful transition in to value based care.
Caret Health is an innovative new solution designed to transcend traditional passive data programs by empowering a low-cost centralized team with a hands-on intervention approach that improves engagement, while maximizing quality and financial improvement with little to no resource drain or workflow changes.
