What is a value based reimbursement model (also known as value based purchasing)? In 2008 Rosenthal noted that emerging models of provider-payment were coming and that their adoption would be met with resistance. Today we see that these models have arrived along with the resistance. How does a practice go about maximizing the income from the efforts of improving value?

We see several approaches to the value based revenue enhancement.

The Craftsman approach to value based care

The most common approach is the craftsman physician model. In this model, the craftsman (physician or NP) puts forth their best effort to create a complete working model of the well cared for individual. The problems with this model is that the “individual” process is recreated every time that a different patient comes in. In very few cases is the process standardized.

The Business Systems approach to value based care

In the business systems approach, the patient arrives and the staff know exactly which measures apply to the patient in question. Sometimes the practice uses an aide like caresentry that allows the gaps in care to be identified at the time of care. Tools like these alert the staff to the care gaps and actually take the staff to the place in the chart that information can be updated.

Process of prioritization

How does the practice identify those measures that will produce the greatest revenue impact for the effort? Some insurance carriers will produce care gap reports that will provide the practice with the information necessary to identify what the next percentile of compliance will bring. For example, will getting two more diabetic patients to document their eye exam generate me $1500 more? If so, what on earth do we need to do to get those patients to the optometrist or better yet, just to get their documentation to the insurance companies?

When a practice has a full grasp of the incentives that are available for their goals, they can then set out on a plan to identify those patients that will produce the best results. Obviously we would want all patients to have the same level of care, but when days are short and click fatigue sets in, it may be helpful to prioritize those patients that are going to produce the greatest reward per click.

Available Tools

We have developed a grid of programs and benefits that are available for practice. Please email our office for information related to this sample grid for your consideration.