November 8, 2024
The principles of value-based healthcare include increasing the value of patient care with the money available on the table. This method promotes value, not volume, to ensure that facilities provide adequate quality services for patients' needs. By linking payments and outcomes, VBH aspires to foster a culture of constant improvement in how it delivers care, which should work to the advantage of patients and health plans as more customers become more sensitive to value when selecting their providers.
The most common way health plans evaluate their quality and performance is by using the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS supplies consumers with standards used to gauge health plan measurements, aiding them in comparing performances and selecting their best-suited healthcare coverage.
HEDIS is a collection of quality measures by the National Committee for Quality Assurance (NCQA). This information is followed yearly to gauge the health plan's performance. It also offers important details about the patient groups served. The measures follow up on the care provided, not just the care ordered care.
The amount of HEDIS measures is not fixed and can differ yearly. New ones might be added, while some could be retired or replaced with updated versions. These measures cover important parts of healthcare like prevention care (e.g., tests and vaccinations), handling physical or mental health issues, how easy it is to access care services, patient satisfaction levels, health services used by patients, and resource use.
It helps healthcare plans assess how well they provide quality care to their members with chronic and acute illnesses. HEDIS allows them to evaluate this performance using objective measures, further promoting improvement. It can fairly compare different healthcare plans using the same criteria. This uniformity aids in making informed decisions about selecting a plan.
Data collection for HEDIS comes from different sources, with billing claims being the main and most abundant. This is studied and reported to show the clinical care given to the members of a particular plan.
Billing claims are the main source for gathering data, but plans might also have methods to survey their members or look at medical records for data that is not easy to find in claims. These specific measures encourage providers to submit claims with correct coding, which can capture the required data by HEDIS through administrative efforts to reduce or eliminate a hybrid review necessity.
Higher scores on the HEDIS increase the competitiveness of a given health plan in the market, thus increasing the number of consumers for their service. The score has certain documentation requirements and specific parameters that influence its value. These are enhanced by offering patients care on time and accurately documented within claim codes for all services given in healthcare settings.
However, not being aware and not taking steps towards quality and preventative care needs can affect HEDIS scores negatively. With the rise in HEDIS rates, healthcare providers are poised to jack up their income via pay-for-performance models.
One common problem pertains to wrong claim coding and inadequate documentation in decision support as a regular contributor to the HEDIS scores. These difficulties may be relieved through the use of EHR since they act as a kind of prompt for the care needs of the patients, allow for template form usage, which enforces order and structure as well, and document the data to align with the patient's care process. This approach ensures that correct information is retained, and the quality of services is enhanced. A few other methods providers can use to strengthen their HEDIS score include:
Focusing on value-based care is becoming more and more crucial. Tools like the Healthcare Effectiveness Data and Information Set (HEDIS) are very important for measuring and enhancing health plans' quality of care. This HEDIS gives standard measurements to assess a health insurance plan's performance in different medical service areas. It helps consumers choose their health coverage with information they can trust, as it provides uniform yardsticks for evaluating performance.
