The goals behind the transition toward value-based care are straightforward: improve the patient experience (both in quality and satisfaction), improve the health of populations, and reduce the cost of healthcare. Unfortunately, for many hospitals and other healthcare providers, the path to get there is anything but.
Transitions are never easy or without challenges. One of the most commonly cited barriers to adapting to the shift in payment models is interoperability. Or more accurately, the lack of it.
While the healthcare industry as a whole has come a long way in improving interoperability, value-based care requires an unprecedented amount of health information exchange among providers, patients, and payers.
The good news is that value-based incentive programs will have the biggest impact on the adoption of interoperability. While advances in technology have significant lowered barriers to adopting interoperability, it is the financial impact that will drive the decision to adopt.
The Merit-based Incentive Payment System (MIPS) provides a good framework for exploring performance measures and the role that interoperability plays in quality care improvements and the reporting process.
Merit-based Incentive Payment System
MIPS, a quality payment program, was implemented by the Centers for Medicare & Medicaid Services (CMS). MIPS focuses on four specific areas that are measured through the data clinicians report, including: quality, improvement activities, promoting interoperability, and cost.
Quality Measures – 45% of overall score
The Quality performance category focuses on the healthcare processes, outcomes, and patient experiences of care within 6 categories: Effectiveness, Safety, Efficiency, Patient-Centered, Equitable, and Timely.
Hospitals that successfully demonstrate improvements in the quality of care not only avoid reimbursement penalties, but also may be eligible for potential bonuses.
Interoperability solutions help to enhance care quality by providing reliable access to accurate, up-to-date patient health information at the point of care. The quality and accessibility of healthcare data directly impacts the efficiency, effectiveness, and safety of care delivery. Often this information resides in multiple information systems and is stored in different formats, complicating data exchange.
Improvement Activities – 15% of overall score
The Improvement Activities performance category focuses on rewarding innovation and improvement activities that contribute to care quality. It is important for providers to embrace innovation in order to expand care coordination, improve patient engagement in care, enable clinician and patient shared decision-making, implement patient safety practices, and expand practice access.
Interoperability is essential in enabling clinicians, physicians from various specialties, and other members of the care team to access comprehensive data no matter where the patient receives care. The combination of information and expertise creates a strong foundation for care coordination. Additionally, the aggregation of patient data from across the entire continuum of care can help reduce the burden on communities by improving population health through initiatives such as social determinants of health.
Promoting Interoperability – 25% of overall score
The Promoting Interoperability category promotes patient engagement and electronic exchange of information data using certified health record technology (CEHRT).
This includes measures organized under 4 objectives: e-Prescribing, Provider to Patient Exchange, Health Information Exchange, and Public Health and Clinical Data Exchange.
Achieving healthcare interoperability enables providers across the care continuum to coordinate better care for patients to further improve the cost and quality outcomes regardless of where treatment is provided. Interoperability facilitates the delivery of care in a matter that is appropriate, secure, timely, and reliable. Information exchange can also support patient engagement activities such as home monitoring and other patient-reported outcomes.
Cost Measures – 15% of overall score
The Cost performance category accesses the beneficiary’s total cost of care during the year, during a hospital stay, and/or over 8 episodes of care. All providers are evaluated on the same 10 cost measures based on a combination of the patient’s procedure and medication condition.
CMS uses Medicare claims data to calculate cost measure performance, which means clinicians and groups do not have to submit any data for this performance category.
Provider organizations are aiming to improve interoperability both operationally and within the community to allow greater transparency into financial and clinical information. While there are no reporting requirements for the Cost performance category, interoperability has a role to play in the submission of clean and complete claims.
Iguana ensures that all submitted claims are complete and can automate the validation and submission of such claims to ensure maximum reimbursement is received. Notifications can be used to alert the appropriate staff when there are potential issues such as missing information before the claim is submitted for processing. This enables providers to submit clean claims the first time to avoid missing out on reimbursements.
Healthcare Providers Can Thrive in Value-based Care Environments
Interoperability accelerates the adoption of value-based care models by increasing data access and sharing capabilities. As payers and providers align toward the goal of standardizing these programs and processes resulting in higher quality patient-focused care, interoperability will only play an even larger role. Collaboration among providers across the care continuum is key to maximizing the achievement of value-based care.
System interoperability is the pinnacle of achieving complete, coordinated, and value-based healthcare. Modern interoperability solutions, such as the Iguana integration engine, enable healthcare organizations to meet the care delivery and reporting requirements as outlined by reimbursement programs such as MIPS.
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To learn more on how iNTERFACEWARE® and the Iguana® integration engine can help your hospital to successfully transition to value-based care, reach out and talk to us today!