As with any major change, transitioning from volume-based healthcare to value-based healthcare and its associated alternative payment model (APM) presents Accountable Care Organizations (ACOs) with many challenges.

value-based care- how integrated platforms can help acos make the transition to apms

Value-based Care Requires Different Data

Value-based care requires complex and comprehensive data collection, analysis, and reporting. No longer is the healthcare provider merely ordering a prescription or medical test in exchange for a fee. APM reimbursement is based on costs and outcomes of the patient’s care over time.

Because of this, value-based care demands a more holistic view of the patient’s health and treatment. In the value-based care approach to healthcare, a patient’s care may require a combination of services, support, and treatments. All of which need to be scheduled, coordinated, and the results tracked before a request for reimbursement can be submitted to Medicare.

To be effective, the information systems used by the value-based care provider, all of their partners and support personnel (i.e., the ACOs), and plan members have to be able to work across functions: tracking each step, collecting data from each one, sharing the relevant data back and forth, and, ultimately, presenting aggregate results.

This can mean accessing different information systems for different functions. An EHR (electronic health records) system to see the patient’s health history and record notes from the current consultation or therapy session. A scheduling system to plan out care appointments, often with different providers at different sites. Another scheduling system to procure nontraditional services, like transportation or meal delivery. A billing system to report results for submitting Medicare reimbursement requests. The list can go on and on.

In short, value-based care requires providers and their partners to access more than one information system to manage each patient’s care from start to finish.

Lack of Information Integration Is a Barrier to APMs

In reality, most ACOs end up using a collection of information systems to do their work. In this situation, providers find themselves logging into several discrete systems simultaneously. One for the patient record and another to review established clinical pathways. Yet another to schedule and coordinate ancillary services and so on. All to navigate the care pathway for a single patient.

It’s easy to ask why not simply use a single, all-encompassing information system? The answer is that no such system exists. And if it did, the Accountable Care Organizations would face the tremendous hurdles of cost of conversion and then training all its providers to use a completely new system.

So ACOs have established their hybrid information systems, connecting the tools and systems they have in place to make their patient care workflows. This can require providers to log on to different information systems for different tasks, switching back and forth as they go. Such ad-hoc arrangements are anything but easy-to-use.

Get access to a full suite of care delivery services through RainbowCare, a digitally integrated healthcare platform helping to close gaps in care and increase member engagement.

Easier-to-use Tools Help in the Transition to Value-based Care

Get access to a full suite of care delivery services through RainbowCare, a digitally integrated healthcare platform helping to close gaps in care and increase member engagement.

Deloitte reports that “Giv[ing] physicians easier-to-use tools for decision-making and performance improvement” is key to helping healthcare organizations move decisively toward a value-based model.

One such tool is an integrating platform that brings together all the necessary healthcare information systems behind a single, unified user interface.

Mobisoft Infotech’s RainbowCare integrated platform makes the tools already in place easier to use by providing a user-friendly single-sign-on portal, not just for providers but also concierge teams and health plan members.

1 For Providers

RainbowCare creates seamless clinical workflows resulting in highly effective, standardized care. Scheduling and documenting housecalls, telemedicine sessions, and in-person visits are all integrated into RainbowCare.

2 For the Concierge Team

RainbowCare provides the means to identify each patient’s unique needs and establish customized care plans that drive better health outcomes. It makes it easy to schedule and document non-traditional care sessions like nutritional counseling delivered through telemedicine. And it enables the management of supplemental services like scheduling patient transportation via the NEMT platform.

3 For Health Plan Members

RainbowCare delivers a self-serve platform that promotes member empowerment. Members have direct access to easy-to-understand benefits and care information making it easier to navigate their healthcare. Ultimately, this ease and feeling of empowerment get reflected in higher star ratings for Medicare Advantage plans.

For all these stakeholders RainbowCare simplifies both human-based interactions and digital communications. This allows providers, concierge team members, and plan members to communicate directly with each other, whether it be by text, email, telephone, or live chat.

Final Thoughts,

When RainbowCare brings all this together, it makes care coordination, care delivery, and result measurement more efficient and effective. This drives cost savings and better health outcomes—just the kind of results needed to satisfy APMs and establish truly value-based healthcare.

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Author's Bio

Ayushi Patel Mobisoft Infotech

Ayushi Patel

Ayushi Patel is the Director of Strategy & Innovation at Mobisoft Infotech. She leads the strategic partnerships and initiatives in the healthcare division. Her experience includes healthcare administration, business development and sales, and customer success management.