Healthcare at a Tipping Point

Value Based Care ‐
for All

Your health is at risk due to the slow adoption of Value-Based Care – a healthcare model where providers are paid based on the quality of care they deliver to patients.

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How This Effects You

Value-based care rewards providers for delivering superior care that lowers costs and improves patient outcomes. Value-based Care (VBC) is proven to prioritize the quality of care over the volume of services provided.

Medicare Advantage is an example of value-based care. It’s taken 25 years for just 54% of Medicare recipients to enroll in Medicare Advantage plans and experience better quality for lower costs.

Value-based care elements initiated by CMS are eventually adopted by private health insurance companies. For example, the annual checkups most private health insurance companies provide were first instituted by CMS for Medicare and Medicaid beneficiaries.

  • You want lower healthcare premiums and stop rising costs.
  • You want superior care for yourself and your family.
  • You want better patient outcomes.

You want Value-Based Care.

CMS 2030 Goal

Value-Based Care is Within Reach

CMS (The Centers for Medicare & Medicaid Services) set an ambitious goal for 2030: to engage the remaining 46% of Medicare fee-for-service and most Medicaid beneficiaries in value-based care arrangements over the next 5 years.

This nationwide initiative is pivotal in shifting from a “paternalistic” model of medicine to an era where providers are increasingly accountable for quality and cost care, patients participate in Shared-Decision Making (SDM).

Crucial Elements

Full Adoption for Success

“What is abundantly clear is that it is behavior, rather than technology, that is far and away the biggest impediment to progress.”

Micky Tripathi, HHS Assistant Secretary

Eliminate Information Blocking
Healthcare must eliminate its data silos by enforcing compliance with The Cures Act legislation that addresses the secure flow of community patient information.
Expedite Focus on Population Health
Patient care teams and aligned business operations must learn and apply new methods to proactively identify, monitor, and respond to the health outcomes of a group of individuals.
Embrace Patient Technology
Utilize mobile technologies that align the patient or caregiver with their care team share relevant information and streamline communication.
Information-Blocking

How Information Blocking Occurs

Information Blocking occurs when an Actor (a health information exchange, certain health IT developers, and healthcare providers) restricts the flow of electronic health information (EHI) as legislated under The Cures Act .

Since 2023, The Cures Act has legislated a patient, their representatives, and providers are given free access to electronic health information (EHI) by an Actor.

Examples of information blocking:

  • An HIE responds slowly or charges fees for electronic health information (EHI) requested by a health organization.
  • Patients are not granted access to their personal data by an Actor.
  • Providers require patients to come to an office visit to receive test results instead of providing them electronically
  • A health organization or health technology company imposing unreasonable technical barriers to data exchange
  • A provider refusing to share medical records with another provider without a valid reason

Action to Stop Information Blocking

Information Blocking is impacting the patient, the caregiver, and the provider. Here are a few scenarios and steps to take.

Patient Access to Their Electronic Information
Providers, HIEs (hospital information exchange), and payers (health insurers) store patient information to conform with HIPAA legislation. Contact the provider, HIE, or insurer to request access to your electronic information.
Provider Access to Patient Data in an HIE or Another Provider
To accelerate the adoption of  Value-based care, The Cures Act legislates free access by a provider to patient electronic health information (EHI) .  Contact the provider or HIE to request access to electronic health information needed to support your population’s health workflows like transition of care, reducing readmissions, and patient engagement.
Patient Access to Their Medicare Information
Medicare beneficiaries have free access to their electronic health information (EHI) stored by their health plan as well as CMS.  Contact the health plan for access.  Medicare patient information is available at the MyMedicare.gov website.  The CMS initiative, Blue Button provides a marketplace of mobile apps providing connectivity to Medicare information.