What Is Value-Based Care? Compliance Is Not The Sole Measure of Quality

In recent years, compliance has dictated the ways in which providers and payers deliver, bill, and measure the quality of home care. But as the value-based care model expands, compliance and quantity are no longer the sole measures of quality for in-home care.

In early January 2021, the Centers for Medicare and Medicaid Services (CMS) announced its plan to expand the value-based care model for all providers, including home health agencies. Value-based care is a concept designed to reward home health agencies for high-quality care and improving overall population health while reducing Medicare spending. This is accomplished by increasing accountability of the healthcare delivery system.

CMS, as a significant funder of state Medicaid, has driven the value-based care and payments model down to the state level as a requirement. As more states implement value-based care payments and incentives, it’s important to understand how this will affect care at every level — from state payers to MCOs to providers.

Sandata is a national leader in homecare management software and is ready to help payers and providers understand how to deliver value-based care by providing optimal client outcomes and maximizing the benefits of this opportunity.

The Importance of Value-Based Care

Value-based care is a healthcare delivery model that revolves around positive outcomes rather than meeting a set of minimum standards with uniform programs of care.

“Value Based Care is the here, and is the model of the future,” said Phil Feldman, Sandata Vice President, Revenue Cycle Management. “It clearly supports the value proposition of custodial home care so is a tremendous opportunity for our industry. Forward-thinking providers are executing by initiating the necessary processes, knowledge base, relationships, and technology to support this. It will soon be a universal requirement, but the smart providers are engaging now.”

Value-based care will facilitate the achievement of a client’s goals rather than following a uniform program. For example, a client who recently experienced a fall might have a goal of walking in their home without assistance. Rather than being assigned a standard amount and type of care that traditionally was used to fit that situation, value-based care will offer a tailored care plan that works towards their goal, the progress of which will be monitored and measured.

These goals and resulting care plans are designed in collaboration with homecare providers, doctors, and payers and aim to deliver the most effective and highest quality care to patients while avoiding care that can lead to repeated hospital visits, future injuries, and overall lower quality of life and health of the population.

Changing How We Deliver Care

Value-based care will impact the way direct support professionals (DSPs) interact with clients, provide care, and chart visits. DSPs will need to be more observant, trained for broader quality guidelines, and need to ask more questions beyond the care plans of the past. Working with clinical supervisors, they will need to focus on minimizing adverse events, such as emergency room visits and hospitalizations, and ensuring clients’ overall health. They will be asked to look for things like fall risks, diet and medication compliance, and other in-home factors that could be affecting a patient’s health.

The value-based model will encourage innovation and efficiency, allowing home care agencies to better fulfill their mission of caring for clients.

Value-Based Incentives

Under the value-based care model, providers and payers will work in tandem to reach the patient’s desired outcome but the underlying goal is much broader — value-based care aims to improve population health overall while bringing medical costs under control.

Simply put, better quality care is better for everyone. The population at large will experience better long-term health, providers will be able to better fulfill their mission to help people, and payers can extend budgets to more consumers in need.

Many payers are implementing value-based programs that reward healthcare providers with incentivized payments for the quality of care they give to patients. These incentives are measured against the desired outcome for a consumer population overall.

CMS’ budgets will allot for value-based payments to the states, which will be distributed to payers and flowed to providers based on the outcomes. Managed Care Organizations will receive bonuses based on their overall population health, which will then be distributed to providers that are meeting value-based criteria for their client populations.

These programs and incentives are part of the larger quality strategy to reform how healthcare is delivered and paid.

Implementing Value-Based Care with Sandata

Sandata software and tools support agencies as they navigate the more robust and detailed requirements of value-based care that reach further than compliance with Electronic Visit Verification (EVV). Our adaptive and innovative software will help providers facilitate value-based care with improved charting, authorization, care-plan compliance, billing, and payment tracking. Implementing value-based care will require an ongoing dialogue between agencies, DSPs, and payers, and Sandata’s system supports this communication with notifications, reports, and care tracking.

Sandata Point of Care helps agencies collect and assess data, develop a clear care plan, and support caregivers’ delivery of outcome-based care. Our software will continue to maximize agency profitability by reducing costs associated with managing paper documents, increasing transparency of training requirements, offering easy-to-access reports for assessing and providing care, reporting metrics to payers, and tracking achievement receipt of bonuses and payments of value-based incentives.

Our software provides the means for clinical management to put the care plan and value-based requirements into the hands of the DSP, make it easier to retrieve information when measuring success, produce reports for clinical management, and help compare quality metrics in order to continually assess, adjust, and maximize the quality of care delivered.

Value-based care can seem challenging to implement and navigate but with a history of supporting over 15,000 providers, 21 state payers, and 50 managed care organizations through changing compliance regulations, Sandata’s team, software, and services are poised to make value-based care easier from Day One.

See how your agency can unlock better profitability and better care than ever before with Sandata.