The transition from reimbursement models that pay for volume of services to those that reward for value and positive outcomes is in reality a slow and arduous road to travel. While there is agreement that value is a much better concept to base payments on, getting there is a complex endeavor in the convoluted world of healthcare reimbursements. However, as our healthcare system continues to move toward value-based systems, it is important for laboratory professionals to understand how this shift impacts their service and where laboratory data comes into play in value-based contracts.
How Does the Laboratory Help?
It is important for laboratory professionals to have a general understanding of the payment model progression to value-based, outcome driven models. In addition, it is wise to have knowledge about what value-based contracts are in play within your parent organizations and which of the measures involve laboratory data.
Healthcare’s Payment Model Progression
Historically, healthcare has operated with fee-for-service (FFS) payment models in place that focus on delivering the greatest number of services to the most patients possible according to a fee schedule. In contrast, the goal of value-based care is to improve the quality of care and patient outcomes while simultaneously reducing healthcare costs. A shared-savings or value-based contract (VBC), where quality is measured and costs are kept below a defined threshold, results in a larger pool for reimbursements, so both quality outcomes and conscientious spending are incentivized. Most healthcare organizations are somewhere in between these models.
Download Orchard's White Paper, What Laboratories Need to Know About Value-based Contracting
How Value-based Care Performance Is Measured
The goal of value-based care is to improve the quality of care and patient outcomes while simultaneously reducing healthcare costs. Value is measured through a combination of quality, cost efficiency, and patient satisfaction indicators.
One important factor in value-based reimbursement models is measuring quality patient outcomes. To capture these metrics, it is necessary to comprehensively and accurately document patient health statuses to ensure better care outcomes and improved population health management. There are several systems available for reporting quality measures (e.g., HEDIS, Medicare Star Ratings, Core Quality Measures).
How the Laboratory’s Data Can Assist with Population Health Management & VBC
Does your laboratory have metrics for chronic conditions that can impact VBC? Does your laboratory have data that can help track preventive screenings or patients who need to return for follow-up lab testing?
As the transition to value-based contracts continues, there are opportunities for leaders who can tie laboratory testing and/or POCT to VBC performance. Laboratory and POC testing is important in the categories that are tracking adherence to preventive care protocols (e.g., colorectal cancer, cervical cancer screening) and chronic disease management (e.g., diabetes, chronic kidney disease).
To learn more about how your laboratory can add value to value-based contracts, watch the on-demand webinar, The Role of POCT in the World of Value-based Contracts.
On-demand Webinar: The Role of POCT in the World of Value-based Contracts
Know Your Lab’s Value in VBC
To increase your laboratory’s value and extend your reach beyond the lab, knowledge about your facility’s involvement in value-based contracting is essential. A laboratory increases its value to patients and its parent healthcare organization by helping to ensure the organization’s success in its value-based contracts. As healthcare’s move to a greater focus on value continues, so should the laboratory’s efforts to share data and expand its role in patient care.
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