A New Approach to Value-Based Care: Diagnostically Connecting Data and Diagnoses

A New Approach to Value-Based Care: Diagnostically Connecting Data and Diagnoses

The conventional transactional method of coding diagnoses for billing in a fee-for-service setting falls short in meeting the care needs of value-based care (VBC) programs. Effective management of patients' chronic conditions and prevention of complications, such as hospital readmissions and costly interventions, are key objectives of Medicare Advantage (MA) and other VBC programs. To ensure accurate compensation for providers, VBC programs rely on clinical risk scores derived from patient diagnoses. A more robust approach is necessary, empowering providers with the necessary information and tools to effectively manage patient care within VBC programs.

Medigy Insights

The traditional transactional approach to coding diagnoses for billing in a fee-for-service environment inadequately addresses the care requirements of value-based care (VBC) programs. Medicare Advantage (MA) and other VBC programs prioritize the effective management of patients' chronic conditions and the prevention of complications, such as hospital readmissions and costly interventions. Accurate compensation for providers in VBC programs relies on clinical risk scores derived from patient diagnoses. Thus, a more comprehensive approach is essential, equipping providers with the requisite information and tools for efficient patient care management within VBC programs.


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