The healthcare industry’s shift from the traditional fee-for-service model to a value-based model has placed an increased emphasis on the quality of care delivery. For example, the Centers for Medicare and Medicaid Services have now implemented a quality payment incentive program that rewards value and outcomes in one of the following two manners: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
Under MIPS, performance is measured through data reported by clinicians in four areas, including quality improvement activities. The quality performance measure focuses on the healthcare processes, outcomes, and patient experiences of care within six specific areas of improvement: effectiveness, safety, efficiency, patient-centeredness, equitableness, and timeliness. This measure is critical, accounting for 45% of a hospital’s overall score. Poor scores in this category can result in a reduction of value-based payments by 2%, while positive quality performance category scores offer full reimbursements as well as potential bonuses.
The Role of Healthcare Data Interoperability
An essential component of delivering quality care is through effective care coordination between physicians, nurses, pharmacists, behavioral health specialists, insurance plans, community-based organizations, and more. The primary focus is to improve the communication and information exchange in care transitions to reduce the possibility of breakdowns in care delivery—which simultaneously allows for better decision making, treatment plans, and health outcomes.
A comprehensive integration solution that enables rapid, reliable healthcare data interoperability can play a significant role in care coordination and improving the quality of care delivery by seamlessly facilitating communication and collaboration amongst various health providers across care facilities.
Here’s how interoperability specifically helps to address each of the following quality performance categories:
Secure: Facilitates the rapid and reliable exchange of information to ensure that necessary patient information is always available and up-to-date.
Efficient: Streamlines communication and consolidates information. Allows increased access to information regarding patient health history, regardless of the facility, specialist, or physician seen.
Patient-Centered: Enables healthcare providers to provide more effective care to their patients by making patient health information available across all care settings.
Equitable: Ensures providers offer a consistent quality of care regardless of a patient’s characteristics.
Timely: Complete patient information is always available at the point of care.
Stay tuned for our upcoming whitepaper, Improving Quality of Care Delivery with Interoperability, to learn more — including an example of how Northern Physicians Organization, a physician-led group aligning doctors’ processes, communications, best practices and ideas, improved care coordination by simplifying the exchange of information during transitions of care.