Industry collaboration is needed to streamline the exchange of value-based payment information, according to a new report.
The CAQH CORE report has a unique perspective on how the value-based payment environment is repeating the scenario that emerged in the fee-for-service environment more than two decades ago, when the adoption of electronic transactions was slowed due to a lack of common rules for uniform use, according to Erin Weber, CAQH CORE director. It also identifies opportunities for the industry to come together now to fix the problem. CAQH CORE is a nonprofit collaboration of more than 130 public and private health plans, hospitals and health systems, vendors, and other stakeholders across the industry that helps stakeholders adopt electronic transactions and exchange data efficiently.
For the study, CAQH CORE interviewed representatives of more than 20 organizations experienced in value-based payments and surveyed CAQH CORE participating organizations. The study also included literature reviews and an environmental scan.
“Value-based payment models are transforming a sizable portion of the U.S. healthcare economy by aligning provider compensation with improvements in care and cost controls,” says Weber. “However, this shift in the way care is measured, billed, and paid is far from complete or certain. Innovation and experimentation are ongoing, and a range of issues could slow or add costs to progress. The research identified five areas of opportunity to streamline the exchange of value-based payment information, including data quality and uniformity, interoperability, patient risk stratification, provider attribution, and quality measurements.”
Value-based payment is coming, yet there is no uniformity on a basic level for operations, according to Weber.
“While innovation is needed, it is important that the industry find a common foundation for basic administrative operations otherwise health plans and providers will add costs to their bottom line and waste time that could be spent on providing care,” she says. “The research identifies a select set of opportunities where a more uniform approach would streamline value-based payment operations for both health plans and providers without compromising the competitive value of value-based payment models.”
Weber offers healthcare executives five ways to streamline value-based care implementation:
- Ensure data quality and uniformity. “Maximize efficiency and minimize misinterpretations by having data element standards and uniform terminology,” Weber says.
- Make value-based payments interoperable. Use existing and emerging standards and technologies, and catalog best practices, Weber says.
- Measure patient risk stratification. “Measuring risk is an essential part of value-based care,” Weber says. “Industry collaboration is needed to increase awareness of the threats that inaccurate data, or lack thereof, and methodology variation pose to value-based payment success.”
- Ensure provider attribution. “In value-based payment models, healthcare providers take responsibility for the care of specific patients, making it important that there is a standard attribution methodology with clearly defined and accurate provider data, and streamlined, transparent attribution models,” Weber says.
- Address quality measurement. Responding to the growing number of clinical quality measurement programs has become an operational burden for providers, according to Weber. “To ease this, CAQH CORE recommends industry efforts to address quality measure challenges and promote harmonization,” she says.