4 Ways Consensus Quality Measures Will Fuel
Value-based Reimbursement

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Each new value-based reimbursement (VBR) model comes with the same promise: better patient outcomes at less cost with providers being rewarded for achieving those desired results. Each VBR model also comes with a different and unique set of clinical quality performance measures for participating providers.

As the number and complexity of VBR models grow, so do the number and complexity of the quality performance reporting requirements on providers. For many providers, the compliance burden of the reporting requirements exceeds the value they bring to care delivery. For some, that means spending more time on compliance and less time on patient care. For others, that means taking a pass on VBR opportunities that can benefit them and their patients.

Easing the Quality Measures Reporting Burden

Attaching a dollar amount to that compliance burden was a recent study in the March issue of Health Affairs that estimated that physician practices spend $15.4 billion each year to report quality measures to public- and private-sector payers. The study said, “While much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report.”

quotation marksBy reducing the compliance burden and demonstrating the correlation with better clinical and financial results, a common set of quality measures will encourage more physician practices to participate in VBR arrangements. quotation marks

Almost as if it anticipated the study in Health Affairs, the Centers for Medicare & Medicaid Services in February made a game-changing announcement that affects the quality measures reporting requirements on providers generally and on physician practices specifically. The CMS said it and major private health insurers and major physician organizations agreed to standardized core sets of quality measures for seven delivery models and clinical services lines. In short, the agreement means that physician groups will be collecting and reporting the same set of quality measures to all payers for a particular delivery model or clinical service line.

Four Ways the Consensus Drives System-Wide Value

I believe that the stakeholder consensus on the reportable quality measures for seven delivery models and clinical service lines drives value to the health care system in four ways.

The first -- and most obvious way -- is reducing the compliance burden on physicians. With a common set of measures, no matter which payer a practice is working with, physicians are collecting and reporting the same information rather than collecting and reporting different information for each payer. That frees physicians up to focus on what's really important, and that's the practice of medicine.

The second way is drawing a closer connection between clinical performance and reimbursement. A common set of measures focused on outcomes makes it easier for physicians to see how what they do affects the health of their patients and the financial performance of their practice. The data become meaningful measures of consistent expectations of their work rather than inconsequential numbers required by different payers.

Third, by reducing the compliance burden and demonstrating the correlation with better clinical and financial results, a common set of quality measures will encourage more physician practices to participate in VBR arrangements. When that happens, the entire health care system and all its stakeholders benefit, particularly patients, as the share of total payments based on performance grows.

Fourth, a common set of quality measures fosters collaboration between providers and payers, especially when it comes to contract negotiations. Rather than negotiating over what measures have to be reported and how much has to be reported, providers and payers can focus on how to use the information to improve care and eliminate unnecessary costs.

Interested in a manageable and successful path to participating in VBR arrangements? Learn about McKesson's Value-Based Care Services.

A portion of this post was published on the mckesson.com blog on April 25, 2016.

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About Jeb Dunkelberger

Jeb Dunkelberger

Jeb Dunkelberger is executive director of corporate partnerships, McKesson Business Performance Services. His core focus is in accountable care services. In this role, Jeb integrates a plethora of healthcare stakeholders in revolutionary care delivery models designed for the evolving complexities of today’s healthcare sector.