Healthcare delivery and reimbursement is changing with government programs and commercial payers shifting from fee-for-service (FFS) to fee-for-value (FFV). With increasing downward pressure on traditional payment methods and rapidly evolving incentive- based and at-risk contracts and programs, healthcare providers find themselves managing across the divide of an industry in transition. To survive and thrive in this changing world, healthcare organizations need timely, accurate, consistent information. They must hardwire performance and understanding what you have to measure.
Building new capabilities for performance measurement while also supporting existing programs puts tremendous pressure on healthcare organizations. Each new FFV program or contract – such as Meaningful Use, Value-based Purchasing, Medicare Shared Savings, and Massachusetts’ Alternative Quality Contracts (Blue Cross Blue Shield) – requires calculating and monitoring a range of metrics. Data accuracy is paramount. Workflow and processes must change to achieve quality outcomes. As risk-based contracts and incentive programs expand, the need to consolidate and coordinate the efforts associated with measures reporting becomes even more crucial. This avoids duplication of metrics reporting and the supporting resources – as well as conflicting reporting.
Our Solution
No matter where an organization is on the journey to fee-for-value, Encore can help manage measures-based components of performance to maximize quality, obtain incentives, and avoid penalties. With our combination of subject matter experts, proven methodologies, tools, and experience with large healthcare systems, we can ease the burden of the unrelenting demand for value management. Encore’s Measures-based Value Performance (MVP) service offerings include assessment, strategy, planning, data services, tools, implementation, and on-going performance management including a full risk/reward multi-year program. Our services can be tailored to meet your needs – ensuring the trusted data and supporting processes required for improving performance and maximizing incentives.
Benefits of Encore’s MVP Services
- Improved financials: By focusing on those measures that impact your bottom line, we help you gain incentives and avoid penalties. We’ll even take the step to share risk and reward in a multi-year partnership.
- Added clarity and speed to performance improvement: Encore’s methodology and tools tie measures to data to workflow, so we know how to change workflows to get better results. Our knowledge bases include over 350 eMeasure and manual measure specifications. As new needs arise, our tools accelerate the creation of additional measures.
- More natural workflow with expert change management: Ensuring accurate data needed for measures often means changing workflow. Encore’s deep experience in EHR remediation, workflow redesign, and change management (training, communication and process redesign) smoothly integrates the capture of data needed for measures into daily workflow. This approach supports user adoption to manage and sustain change.
- The right structure for measures and performance improvement: Encore’s approach provides the foundation for data governance, accelerates the availability of source data for use in measurement and analytics, and creates transparent, trusted data for the organization.
Our Approach
Encore’s MVP program begins with an assessment that identifies the dollars and associated measures at stake across your portfolio of at-risk, incentive-based contracts and programs. This assessment identifies gaps and informs the creation of a roadmap to close those gaps. As input into that roadmap, we assess the data in your EHR and other source systems to determine whether you are capturing the right data for the measures in your portfolio of value-driven programs and contracts. The roadmap defines the multi-year data and process program required to obtain the desired incentives. Encore’s team includes experts in contracting, clinical processes and change management, data and workflow, measures, and technology. Led by strong program management, this team develops a complete program to manage your organization’s value-based measures.
Next, we can implement any and all aspects of the roadmap to establish required program and data governance, technology, and data tools. Our services can include EHR remediation, workflow redesign, change management, data services (profiling and extracting, transforming and loading) and the dashboards needed to monitor and improve performance across your FFV programs and contracts.
Once the MVP program foundation has been established, the value management cycle begins. Encore can help monitor and analyze your performance, providing insights and suggestions for needed improvements to meet your targeted incentives and enhance quality of care. As you sign new contracts and adopt new programs, we can help you to incorporate new measures and targets into the program. Through trusted, transparent data, Encore supports your transition to new payment model requirements that use measures to adhere to evidence-based standards.
The result? Better patient care and an improved bottom line. These services can be provided as a shared risk program or on an advisory basis.
