Investment in technology is imperative for providers who want to keep up with the changing healthcare reimbursement landscape. As patients are paying more out-of-pocket for their healthcare and becoming even more accustomed to service-based consumerism, their standards for how they receive care are shifting. Patients want quality, convenience, respect, security, and cost-effectiveness, as with any other service they receive.

Not only are expectations rising, but patient satisfaction can carry its weight in gold when it comes to value-based reimbursement (VBR) contracts. For example, the Centers for Medicare and Medicaid Services (CMS) measures patient satisfaction as one-fourth of their total performance score. The performance score is tied to how much CMS will reimburse the hospitals for the care that they provided. Over 4,000 hospitals participated in 2017, with more than 8,000 patients completing the survey per day. Hospitals have successfully boosted scores – and in turn reimbursement – by focusing on patient care coordination. One hospital boosted scores by 5% through efforts such as creating multidisciplinary teams of nurses and physicians that are assigned to a certain area of the hospital, then distributing patients so that they are on the right floor for easy access to their care team. They believe that communication is at the heart of patient satisfaction—and now they have results to back it up.

VBR is gaining traction and now represents almost half of reimbursement activities for large payers and health systems. While VBR alternatives have demonstrated value in terms of cost savings and improved quality of care, implementing them efficiently has proved difficult. The reimbursement infrastructure was built to accommodate the fee-for-service model. Flipping that on its head will require payers, providers, and other industry players to forge partnerships that break down data siloes and distribute the knowledge and resources to collect, analyze and interpret data. These partnerships will lay the foundation for payers and providers to effectively manage their VBR contracts and meet patients’ expectations along the way. 

Providers typically do not have the resources to invest in the infrastructure and staffing needed to support analytics and often don’t know how much the care they provide costs. Furthermore, care coordination is complicated by the fact that they usually only have a view into the care provided to patients within their four walls, unless they are part of a larger health system or a closed health system in which the payer and provider are one entity. On the other side, payers don’t have a full view into the patient experience and must often rely on administrative medical claims data that are intended for billing purposes. Third-party vendors with advanced technological capabilities and bleeding-edge innovation can help close the technology gap without payers and providers needing to develop solutions in-house. Without partnerships between payers, providers and industry, integrating the necessary data sources to effectively implement VBR programs will remain a stubborn challenge.

Why This Matters 

In our 2019 Health Trend Ten, we detailed some of the emerging challenges that HCPs face in Trend Six: Rewired HCP. As more patients receive care under VBR contracts, facilitating care coordination, and in turn, patient satisfaction, will remain a challenge for providers if they don’t invest in the infrastructure to support data integration and analytics with payers and other industry partners.

About the Author:

Erica is Director of Insights in Columbus, OH. She has profound interest in generating data-driven insights to improve health and business outcomes. With a PhD in epidemiology and 10 years’ experience in research, analytics, and product development, Erica loves to connect the dots to describe and predict trends in patient health and consumer behavior and elevate product positioning.