How to get financial benefits from PRO’s?

Introduction

In today's value-based healthcare landscape, leveraging Patient Reported Outcomes (PROs) can be a game-changer for payers. This newsletter dives deep into the financial advantages PROs offer, focusing on key areas like MIPS reimbursement, CMS THA/TKA programs, and P4P initiatives.

MIPS Reimbursement

The Merit-based Incentive Payment System (MIPS) ties provider reimbursement to quality metrics. PROs can significantly impact your MIPS score by capturing patient experiences and functional status. By integrating PRO data into your quality reporting, you can demonstrate improved patient outcomes and potentially secure higher reimbursements.

CMS THA/TKA Programs

The Centers for Medicare & Medicaid Services (CMS) has implemented bundled payment programs for Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). These programs incentivize cost-effective care. PRO data on pain management, mobility, and function recovery can be invaluable in demonstrating program success and potentially lowering costs, leading to higher profitability.

Some data points that will prove the point

A study published in JAMA Surgery found that using PRO data in a THA bundled payment program led to a 10% reduction in healthcare costs [Link to study]

P4P Programs

Many private payers offer Pay-for-Performance (P4P) programs that reward providers for meeting specific quality benchmarks. PRO data can be a key differentiator in these programs. By showcasing improved patient outcomes through PRO measurement, you can position your network for increased financial rewards from payers.

Taking Action

Ready to unlock the financial potential of PROs? Here are some steps:

Invest in PRO collection tools: Streamline PRO data capture to ensure efficient integration into quality reporting systems.
Educate providers: Help your network understand the financial benefits of PROs and encourage their active participation in data collection.
Analyze PRO data: Utilize PRO insights to identify areas for improvement and optimize care delivery for better patient outcomes and cost savings.

Some data points that will prove the point

Patient-Centered Outcomes Research Institute (PCORI): Homepage | PCORI (Provides resources and research on PROs)

National Quality Forum (NQF): NQF: Home (Develops quality measures, some of which incorporate PROs)

By strategically leveraging PRO data, payers can achieve significant financial advantages in the evolving healthcare landscape. Stay tuned for future newsletters where we'll explore additional benefits of PROs, including member engagement and improved population health management.

BestOutcomes simplifies PRO data collection, saving time and ensuring accuracy for financial programs. Analyze PRO data with BestOutcomes to showcase value-based care for MIPS and P4P rewards. BestOutcomes helps navigate payer initiatives like THA/TKA to maximize financial benefits. Leverage BestOutcomes to optimize care with PRO data, potentially reducing costs for bundled payment programs.

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