Saturday, February 7, 2015

Big Data and Analytics--The new Currency in Health Care

You are not alone, puzzling just how fee for service payments will change to quality based reimbursement methodology. Obvously the two will exist side by side for the forseeable future. Not all health care payments are amenable to pay for performance or quality based models.  CPT  codes will not disappear. 

With healthcare organizations churning out an increasing volume of clinical, financial, and operational data, IT tools and analytics are becoming essential for business intelligence and predictive capabilities.

The conversion from  volume (or procedural) based reimbursement to one of value-based presents the challenges of measuring new metrics and analyzing their association with diseases and treatment outcomes.   The model is still uncertain and in development..  Physicians must be aware of changes and participate in development of this crucial new paradigm.

The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement

The Affordable Care Act (ACA) places primary care physicians (PCPs) front and center in the mission to improve the health of Americans, and lower overall healthcare costs. But new ACA-derived payment models that reward value, not volume, are driving skepticism and uncertainty among physicians. 
“This is really a tough time because physicians still need high productivity, but they also need to start measuring value,” she says. “The levers haven’t really switched from productivity to quality and value, but you don’t want to have a learning curve that is so steep you can’t deal with it when the switch gets flipped.”
Reform, however, doesn’t mean physicians will be paid less, counters Reid Blackwelder, MD, FAAFP, president of the American Academy of Family Physicians. Cost savings to the system from better efficiency and reduced duplication of services should benefit physicians.

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