By Tony Schueth, CEO & Managing Partner
How we pay for health care is undergoing a disruptive, fundamental shift. We rapidly are moving away from the traditional fee-for-service, pay-for-volume approach to one that pays for demonstrated value. In fact, this shift is happening faster than expected. According to one estimate, two-thirds of reimbursements now are based on value and fee-for-service reimbursement should fall below 26% by 2021.
Electronic health records (EHRs) and automated processes are the tools powering this change. Stakeholders are looking to electronic data exchange and analysis to improve patient engagement and quality of care as well as reduce costs.
Many activities are underway to leverage health information technology to achieve the value in value-based care. Here are four predictions for 2019.
Looking Ahead. Standards development and multi-stakeholder initiatives are key to advancing ePA, RTPBC, real-time medical benefit check and value-based care. The National Council for Prescription Drug Programs (NCPDP) is actively working to refine and develop standards to advance widespread industry adoption of RTPBC. Meanwhile, Health Level 7, through the Da Vinci Project, is actively rolling out use cases in support of value-based care data exchange. An example is Coverage Requirements Discovery, for which an implementation guide will be published in the fourth quarter of 2019. This use case will enable providers an application program interface (powered by the Fast Healthcare Interoperability Resources—or FHIR—standard) to discover in real time specific payer requirements that may affect the ability to have certain services or devices covered by the responsible payer.
Conclusion. The Point-of-Care Partners team is actively engaged in all of these areas. What we have reported is a drop in the bucket compared to what is planned, what is in progress and what is to come. Want to know more or become involved? Reach out to me at email@example.com.