As healthcare organizations shift from volume-based to value-based care, payments are increasingly tied to quality and provider performance to align incentives and improve patient experiences. Health centers are at the forefront of adapting to this change as roughly 27 million people -- or 1 in 12 people -- receive care from these sites each year.
Over 2,800 rural health clinics (RHC) and federally qualified health centers (FQHC) depend largely on a combination of reimbursement and Health Resource Services Administration (HRSA) grant funding to deliver high quality, cost effective services. HRSA set out a strategic plan for these sites to position themselves strongly in outcomes-oriented payment models with a clear objective to “provide performance-based awards to grantees that demonstrate improved patient outcomes as reflected by their clinical quality measures, and assist safety-net providers in quality measurement and reporting.”
The annual HRSA Quality Improvement Awards are given to top performing eligible health centers that meet certain clinical quality metrics, with a key category being chronic care management. Health centers have been shown to effectively manage chronic conditions and have proven to save $2,371 per Medicaid beneficiary compared to non-health center beneficiaries, but new approaches are needed to apply these results to increasingly larger populations being served by these clinics.
Improving chronic disease management performance measures
Achieving strong metrics for asthma, diabetes, hypertension, lipid therapy, ischemic vascular disease (where a waxy substance called “plaque” builds up inside blood vessels), and HIV can be challenging. In 2017, only 46 health centers received the highest distinction, known as the “National Quality Leader” award, with an additional 21 receiving the second-highest recognition, a “Delivering High Value Health Care” award. The vast majority of health centers need new tools, technology, and and models of care to adapt to the changing healthcare landscape.
Improving medication adherence is one way to improve chronic disease management performance measures. HRSA-funded health centers are evaluated based on the proportion of patients whose blood sugar (known as hemoglobin A1c) and blood pressure are in a healthy range. For patients who are prescribed medications to treat Type 2 diabetes or high blood pressure, adhering to their regimen is a critical component of managing their condition and improving health outcomes. Higher scores from HRSA related to chronic disease management leads to more funding, lower patient costs, and increased resources to invest in other programs to support patients.
Incentivizing the use of technology for chronic disease management
New Medicare policies are also in place to incentivize providers to leverage technology for chronic disease management and medication adherence. Effective January 1, 2019, the Centers for Medicaid and Medicare Services (CMS) authorized a new virtual communications code for Medicare, known as G0071, which reimburses for the use of technology by providers at FQHCs and RHCs. The code reimburses at a rate beginning at $13.69 per 5-minute virtual encounter through live or asynchronous technology. The code can be utilized to support positive health behaviors in between clinic visits, such as medication adherence, to improve multiple HRSA quality measures more efficiently.
As the shift toward value-based payment models continues, medication adherence will become an even more significant component of supporting patients through chronic disease management. Contact us to learn more about ways that technology is an opportunity to improve performance measures and overall quality of care.