Agencies are operating in a new era in healthcare, where value-based care (VBC) is the standard. Reimbursement is no longer issued based on the number of services provided but rather a holistic evaluation of patient outcomes, quality metrics, and cost efficiency.
The new focus on value should help improve patient care and reduce financial waste. But for agencies, it also means meeting new operational standards for reimbursements. Adopting the right technology is critical to stay compliant and avoid falling behind financially.
This blog breaks down what VBC means for providers and how smart technology solutions like healthcare automation help agencies stay ahead of the competition.
What Is Value-Based Care & Why Does It Matter?
Value-based care is a shift away from volume-based metrics. The reimbursement model rewards agencies that demonstrate cost efficiency, quality, and improved patient outcomes. This new focus is already in place across the home health and hospice sectors, leading agencies to reassess their service delivery.
The push behind this shift comes from private payers and government funders like the Centers for Medicare and Medicaid Services (CMS). Payers are promoting VBC as a way to bring down the costs of healthcare and improve care coordination, ultimately resulting in more favorable patient outcomes.
Agencies receive full reimbursements only if they adhere to these new VBC criteria. They have to meet strict quality metrics, actively track patient progress, and show measurable improvements. Failing to do so can mean reduced payment or nonpayment from public and private funders.
Common Challenges Agencies Face in Adopting Value-Based Care
Even agencies that are in favor of the VBC reimbursement model might face barriers in its implementation. Legacy operations might present some challenges in demonstrating to funders that the agency is meeting VBC standards.
Tracking Quality Metrics Accurately
Home health and hospice agencies often use legacy documentation systems. These might run on outdated technology, resulting in fragmented data. In the age of VBC, agencies need up-to-date, accurate data to demonstrate value. The metrics they must present include:
- Patient progress
- Readmission rates
- Care outcomes
That’s in addition to providing evidence of cost-effective service delivery, another component of the VBC model. Agencies often struggle with this new obligation to provide consistent, reliable data, making it harder to meet the standards of VBC.
Managing Documentation & Compliance
The companion to quality data is thorough documentation. Legacy systems might lack the records needed to prove quality care delivery. Agencies might have record-keeping systems that private or public payers consider incomplete. As a result of missing records, agencies may experience healthcare claim denials, delays in reimbursement, or even penalties due to a lack of proof they're meeting care standards.
Reducing Unnecessary Costs Without Sacrificing Care Quality
Many agencies still rely on manual processes and repetitive tasks. With the new focus on VBC, agencies are required to demonstrate economic value. This means ensuring operational efficiency while maintaining high care standards. Without health documentation automation, it can be challenging to achieve that efficiency.
How Technology Helps Agencies Succeed Under Value-Based Care
A cornerstone of tackling the challenges of VBC is adopting technology that helps your agency improve accuracy, efficiency, and information exchange.
Automating Documentation & Reducing Errors
Technology can help reduce errors and ensure accuracy while saving your team time spent on reporting and data entry. AI-powered documentation tools capture essential patient tracking data in real time. Tools like Referral AI for home health can speed up patient intake and give you a head start on providing quality, efficient care.
Meanwhile, automated workflows alert your team to potential errors that could delay a reimbursement. The right software can flag missing signatures, incomplete orders, and incorrect billing codes.
Enhancing Interoperability & Data Exchange
Communication between care teams, payers, and electronic medical records (EMRs) is at the heart of VBC. Advanced technology facilitates this communication. Platforms like WorldView integrate with major EMRs (KanTime, Axxess, Homecare Homebase, and soon-to-be MatrixCare) to ensure smooth data flow and home health compliance.
Optimizing Revenue Cycle Management
Economic efficiency and revenue optimization is one way agencies can benefit from VBC models. Technology can vastly improve cash flow, forecasting, and billing. AI-driven insights help agencies identify trends in service delivery so they can predict financial risks and speed up reimbursements.
At the same time, automated physician order tracking reduces the time outstanding on physician orders. This allows agencies to bill more quickly, improving the flow of cash back into the organization.
Strengthen Your Agency’s Future with the Right Technology
Value-based care is here to stay. Agencies that rely on manual processes risk falling behind as their primary sources of revenue insist on VBC reimbursement models. By embracing technology, your agency gains a competitive advantage.
WorldView’s Stronger Together Bundle with partners Vivid Health, Care Coordinations, and SimiTree can give your agency a leading edge in the VBC landscape. Our recent webinars can help you understand how this technology bundle elevates agency operations and the role AI-driven automation plays in VBC.
WorldView’s solutions are designed to help agencies navigate VBC with confidence, reducing documentation errors, improving cash flow, and enhancing care quality.
Don’t let administrative burdens and compliance challenges hold your agency back. Discover how the Stronger Together Bundle can help your agency optimize workflows, enhance financial performance, and improve patient care. Schedule a consultation with our team today and see the impact for yourself!
