How Automation Impacts Value-Based Reimbursement

Value-based reimbursement is about the quality, not quantity, of care. And everyone wins when your members receive the services they need effectively and efficiently.

A bundled-payment model can reduce healthcare costs by encouraging greater integration of care teams and better use of existing services and technologies.

Automating processes and communication can:

  • Help providers become more efficient
  • Help providers identify the care members need
  • Fully engage members and providers

Here’s how.

Help Providers Become More Efficient

Value-based reimbursement models are ideal because they incur less waste than fee-for-service models and are focused on incentivizing behavior focused on quality outcomes. Understandably, providers may worry that their costs will outweigh their reimbursements under this model. So to mitigate their risks, they are looking to invest in new technologies and designing new processes to increase efficiency.

Through automation, you can help them become more efficient. Automation reduces administrative costs, makes gaps in care more visible, and speeds up frequent transactions, which makes it easier for providers to deliver cost-effective care and spend more time with their patients (your members).

At its simplest level, automation can pre-populate forms with all the information providers would normally have to enter manually. You can also use automation through services like chatbots, interactive voice recognition (IVR), and automated faxing. Measures like these, while simple, allow providers to quickly get the answers they need and can have significant impact at scale.

Our Authorization Submission application with MCG Connector provides more sophisticated automation. It captures medical necessity data based on your care guidelines and lets you establish “if this, then that” rules that automatically approve or deny authorizations based on your data and provider information. You can even automate responses to let providers know when an authorization is not required so they don’t waste time submitting an authorization unnecessarily. This type of automation supports a value-based reimbursement model by expediting the care your members need.

Better Equip Providers to Identify Gaps in Care

Value-based reimbursement enables providers to focus their efforts on the services and types of care that their patients need and that affect your quality ratings—namely, gaps in care. Unfortunately, providers often don’t have the great visibility that you do into what your members need according to those quality measures.

Applying data and automation to your view of comprehensive member data can offer a better way for providers to see gaps in care and proactively work to close them. The Healthx Quality Measures solution lets providers conveniently explore these gaps in care based on automatically updated data.

Additionally, when providers look up a patient’s eligibility and benefits, our solution displays any gaps in care as an intuitive step in their workflow, so they’re visible at the times when your providers are best positioned to deal with them–like when a patient is checking in or scheduling an appointment.

Closing gaps in care takes a coordinated effort between you, your members, and providers. Automating processes can nudge members and providers to take necessary actions that lead to more efficient use of care, reduced costs, and better outcomes.

Fully Engage Members and Providers

Automated omnichannel communication is the most cost-efficient way to reach members and providers—and the most effective way to drive behavior. Channels like text messaging, chatbots, online alerts and notifications, and mobile apps allow you to tell members and providers what you need them to do, and link directly to where they can go to complete the desired action.

Consider members who haven’t chosen a primary care physician. Now you could have an administrator call those members to ask them to make a choice. But suppose you were able to automatically trigger a text message that they can read at any time, with a link to your online provider directory? Or how about those members who have a gap in care that could be serviced via telemedicine? What if you sent a push notification that included a link to initiate a call with  your telemedicine services?

Or how about those members who frequently make unnecessary trips to the ER, when there’s an urgent care clinic nearby? You can automate messaging that explains how to use their care in more efficient ways, saving money on unnecessary care.

Automation lets you set parameters to trigger communications based on data so that your members know what care they need and have a simple path to get it.

Automation makes the entire system more efficient

Automation makes value-based care more efficient for your providers and more effective for your members by leveraging your data to eliminate tedious manual processes and communicate in more relevant, actionable ways.

Every opportunity you have to automate interactions between you, your providers, and your members is a chance to make the entire healthcare process more cost-effective and to drive engagement outcomes.

Schedule a demo to see our automation tools in action.