Physicians and hospitals are the heart of delivering effective care to patients. Accurate encounter reporting is monitored closely as it is an important element of the prior authorization and reimbursement processes. As providers and the health care ecosystem increasingly move to a value based-based care system, there is clearly a need for better clinical-quality reporting that is also tied to reimbursement.

Although the clarion call to value-based care has been loudly proclaimed, the actual shift from fee-for-service is still gaining steam. A Research Brief published by Health Affairs in December 2022 reported that “more than half of health care payments in the US are still based on fee-for-service.” While that level of value-based care adoption is notable, the view from the physician perspective isn’t as favorable. In fact, the level of value-based care contracting hasn’t been very large at all in some provider segments. In addition, there also remains a large opportunity to include quality performance reporting. Notably, the Medical Group Management Association’s 2022 report on value based care highlighted:

Many forward thinking executives in healthcare are asking “What can be done to accelerate the adoption of value based care by physician groups and hospital systems?” A quick search online of the issue reveals that technology-based tools that merge comprehensive patient health data with performance-based quality reporting facilitate risk-based reimbursement contracting. This mirrors what we’ve seen with some of our clients, who’ve been effectively using innovative hospital quality reporting applications to support management of their value-based provider reimbursement programs.

Health plans play a pivotal role in driving the adoption of value based care. Championing improved clinical quality reporting systems and provider reimbursement models will accelerate the adoption trend.