The manual processes being used by health plans and provider groups lack sustainability, in an environment realizing a rapid expansion of value-based care payment models. Payer and provider C-suites are abandoning their conventional methodology of capturing as much beneficiary market share as possible for a more targeted approach that encompasses the extensiveness, contrast, and intricacies of a systematic value-centric partnership model between payers and providers.
Success is contingent on the ability to act and react in real-time at the moment of provider-patient interaction. It also requires spending time educating your staff on the link between value-based payments and CDI/clinical quality measures. Collaboration with the payers to reconcile quality data and continuous physician clinical reviews will expedite linking an accurate and immediate payment amount. For example, inspiring a PCP to add ten preventative screenings a month would propel the physician into a new quality quartile, yielding a 10% to 20% bonus payment. This is still an emerging space which has yet to be mastered by any organization. Partnering with a robust vendor partner with the depth of experience on both the provider and plan side increases your odds of success. The hard truth is that the amount payer and provider CEOs spend on internal incentives rarely changes provider behavior. This is mainly because the time it takes to manifest a cash reward linked to the provider action can be upwards of 12 to 16 months.
Failure to invest or partner with a vendor experienced with risk adjustment within the next three years will set your organization back and lead to physician burnout and significant losses of value-based revenues. Vee Technologies' Risk Consulting teams are here to help with risk process pain points, build up your internal capabilities to thrive in the risk adjustment space, and help you optimize the bonus payments for your organization.