When value-based care (VBC) payment models made their first big appearance on the healthcare scene more than 10 years ago, provider executives often described themselves as having their feet in two different canoes—with different directions and paces—per the VBC and fee-for-service (FFS) models of care.
Today, we know it’s VBC that’s paddling slowly along, with FFS maintaining a study speed and course across healthcare’s future. We also know that the canoes are not mutually exclusive choices for provider leadership. The two are more catamaran than competing vessels. One is inextricably linked to the other, as FFS can effectively serve as the foundation for provider shift and growth into greater levels of VBC.
What provider organizations need is a core set of strategies that will improve patient care and help increase FFS revenue yet at the same time lay the foundation for value care delivery.
Below are seven equally essential yet independent strategies that provider organizations need to thrive under FFS yet position themselves for the transition to VBC and increasing levels of clinical and financial risk.
- Initial preventive physical examinations (IPPEs) and annual wellness visits (AWVs): Too many provider organizations fail to actively reach out to patients to get IPPEs and AWVs scheduled and completed. Providers can bill for them under FFS and keep patients as healthy as possible—and costs down—via prevention and early intervention under VBC. If physicians are too busy to perform IPPEs and AWVs, one option would be to hire a nurse practitioner or physician assistant to do so.
- Advanced care planning (ACP): Providers can perform ACPs as separate visits or as part of IPPEs and AWVs. Again, providers can bill for them but also keep costs down under VBC as they plan for medical decisions that a patient may need to make because of their condition and status. Plus, providers other than physicians can bill for ACPs, and the time code has no limit.
- Ability to identify and close gaps in care: By evaluating patients’ health status regularly via IPPEs, AWVs and ACPs, providers can identify gaps in a patient’s care and act to close them. What they do to close gaps in care are billable services under FFS, and closing gaps in care is a quality measure under VBC programs like the Merit-Based Incentive Payment System (MIPS).
- Referral management: Actively managing the transition of a patient’s next step in their care—referral for a diagnostic test or to a medical specialist—promotes the coordination of care for that patient and helps eliminate any potential gaps in care that could lead to a poor outcome. Providers can also keep that referral revenue in-network under FFS while keeping patients as healthy as possible under VBC.
- Risk-adjustment factor (RAF) scores and hierarchical condition category (HCC) coding: By successfully identifying potential clinical issues with a patient, providers then have an opportunity to successfully manage those clinical issues. That process, in turn, creates an opportunity for accurate coding. Providers must capture data at each FFS patient encounter to calculate their ongoing RAF score and do HCC coding. That enables them to build a patient population database that stratifies patients based on clinical risk and estimates treatment costs in the future. Accurate coding can increase FFS payments and position a provider to accept capitation payment contracts under VBC.
- Use of chronic care management codes: The clinical issues identified during IPPEs and AWVs often are previously unidentified chronic diseases like diabetes or high blood pressure. Early intervention helps prevent those chronic conditions from escalating into more serious and acute medical conditions. Providers must be adept at using these CPT codes to capture time spent in person or virtually identifying and then managing a patient’s chronic condition. They’re billable under FFS and used collectively to identify and close gaps in care under VBC.
- Use of transition care management codes: Providers use these CPT codes to capture time spent following up with patients with moderately or highly complex medical conditions post-hospital discharge. They’re billable under FFS and used to track management of a patient’s health and prevent them from needing additional care from a specialist or hospital under VBC.
The seven strategies to improve patient care and clinical outcomes are independent of each other, and providers can use each individually. But they’re clearly more powerful when used together. These strategies give providers a systematic way to fully manage the disease and illness of each patient.
That’s good whether a provider is treating a patient under fee-for-service or value-based care. Providers can enjoy both canoes if they paddle FFS and VBC at the same time using these seven core strategies.
Provider organizations can automate and master the seven value-based care strategies with the help of Innovaccer’s healthcare data platform. Contact Innovaccer for a demo today.