The Future of Value-Based Care in Pediatrics

Will your practice’s payment systems look a little different in the near future?

While value-based care has been an emerging trend for years, it's gaining further momentum thanks to new programs introduced by Medicare.

Read on to learn what value-based care entails, what it means for pediatrics, and how your practice can begin making changes today.

What is value-based care?

In simple terms, value-based care means that physicians are paid based on the quality and efficacy of the care they provide. This is different from the more traditional model of healthcare pay: fee-for-service care. Under fee-for-service, physicians are paid a fixed rate for various medical services. In this old model, the more services physicians provided, the more they were paid, without regard to quality. 

Many believe that the fee-for-service model serves to distract providers from focusing on providing quality preventative care. It requires providers to bring in as many new patients as possible in order to make the most money, rewarding physicians who do the most care, but not necessarily the best care.

With value-based care, data is collected on the effectiveness of the care your practice provides. This data could include the personal outcomes of patients, your track record of disease prevention, the level of safety of the care, and whether or not care is easily accessible and provided in a timely manner.

Over the last nine years, Medicare has introduced several government-sponsored programs to move the healthcare industry in the direction of value-based care. Many apply only to large organizations, such as hospitals. 

However, many physicians who are registered Medicare providers now must participate in the MIPS (Merit-based Incentive Payment System) program. MIPS replaced the VM (Value-based Modifier) program which ran from 2015-2018, and expands on its mission to financially reward those who provide top-quality care. 

The program is under the umbrella of the Quality Payment Program. QPP evaluates participating physicians, or groups, and increases pay for clinicians providing high-quality, effective healthcare. It also lowers pay for those not meeting performance standards.

What does this mean for pediatricians? 

Value-based incentive programs may be closer than you think, and they aren’t all federally-based.

Chip Hart, PCC's Director of Pediatric Solutions, has observed that many states have already been implementing value-based incentives for years. Hart notes that physicians in the state of Massachusetts “have received much of their revenue from bonuses paid for quality results for many years.”

Currently, 50% of individuals enrolled in Medicaid and CHIP (Children's Health Insurance Program) are children. Some states have either already implemented, or are undergoing trial runs of, alternative payment system programs similar to MIPS with regard to children on Medicaid. 

In New York, the Commonwealth and United Hospitals funds developed and tested a value-based payment system tailored specifically to children under Medicaid. This was meant to supplement the state’s already existing Medicaid value-based incentives which focused primarily on adult care. 

The New York case study found that a challenge of implementing these programs for children is that children are generally already low-cost and in good health. This means that in terms of preventative care, there is not much of an opportunity to cut costs in the short term. 

On the flip side of that, as a pediatric practice, you know that the healthcare a child receives early on can greatly inform that child’s development. Value-based systems tailored towards children prioritize the early prevention of long-term health issues, cutting healthcare costs down the road.

What changes can pediatricians make today? 

The value of care you provide will be judged on factors including whether or not your treatment is effective, safe, and timely. So developing strong relationships with patients and their families is a must. Ensure immunizations are up-to-date, and that the kids you care for attend their annual well visits. Keep a keen eye on your surrounding community, and how the circumstances of life within it affect general health. Pinpointing common recurring needs is integral when it comes to preventative care.

Investing in a strong EHR system is essential when working with a value-based payment system. A reliable EHR provides quality metrics—for example, immunization status for the practice at large—giving you an idea of how your practice is doing in terms of the value of the care you are providing.

A quality platform also makes it easier to keep an eye on individual patients, and how well you are responding to their health issues. Was the proper care and medication provided, and is the issue now solved? Is the patient due for a well visit?

Finally, getting parents and guardians engaged in their child’s healthcare will improve your quality metrics. With systems like a Patient Portal, guardians can review their child’s health records, book appointments online, and request prescription refills. This ensures that children in your practice remain healthy, and helps establish open communication with their parents. 

Alternative payment methods do not have to be stressful.

Value-based payment systems can ultimately benefit both your practice and the kids you serve. These new systems allow you to focus on quality care rather than patient recruiting, which means a more focused, personal relationship with every family that enters your office.

If you’re worried about the logistics of shifting payment systems, the answer is simple. Contact PCC today. With our pediatric-exclusive EHR system and unbeatable customer satisfaction rates, accessing and monitoring value-based care data is simple. We take the stress out of monitoring your clinic’s metrics, so you can do what you do best: care for your patients.