Care Management Platforms: Supporting Value-Based Care Delivery

Hospitals and medical practices are getting hammered by value-based contracts. You get paid for keeping patients healthy, not just treating them when they're sick. Care Management Platform systems help you track patients between visits, spot problems early, and coordinate care across your entire network.

Most practices still work the old way. Patients show up sick, you treat them, and they leave. That doesn't work when Medicare and insurance companies dock your payments for readmissions and poor outcomes.

What is Care Management?

Care Management is actually keeping track of your patients when they're not in your clinic. You monitor their medications, make sure they follow up with specialists, and catch problems before they land in the emergency room.

Here's what care managers actually do:

• Check on high-risk patients between appointments
• Make sure patients actually take their pills
• Set up appointments with cardiologists and endocrinologists
• Help patients deal with Medicare paperwork and find food banks
• Call patients after hospital discharge to prevent complications

How Do Care Management Platforms Work?

Care Management Platform software pulls information from your EHR, billing system, and lab results to create a complete picture of each patient. Also, it flags patients who missed appointments, haven't filled prescriptions, or have gotten abnormal test results.

The system sends alerts when patients need attention. Maybe someone's blood sugar is running high, or a heart failure patient gained five pounds in three days. Your care manager gets notified and can intervene before things get worse.

Why Healthcare Organizations Need Care Management Solutions?

Care Management Solution technology fixes the biggest problems in value-based care. You can't manage what you can't see, and most practices have no idea what happens to patients between visits.

Without these systems, patients slip through cracks:

• Diabetics stop checking their blood sugar and end up hospitalized
• Heart patients don't weigh themselves daily and go into fluid overload
• Mental health patients stop taking medications and relapse
• Post-surgical patients develop infections that could have been prevented
• Elderly patients fall because no one checked on their home safety

Key Features of Effective Care Management Platforms

Care Management Platform systems need certain features to actually help your practice succeed in value-based care.

What you actually need:

• Risk Scoring: Which patients are going to cost you the most money? The system spots them based on how sick they are and what's happened before.
• Task Management: Your care manager calls 50 patients a week. She needs a way to remember who she called, what they said, and when to call back.
• Patient Communication: Patients call the front desk about everything. Give them another way to ask questions so your staff can do other work.
• Outcome Tracking: Show me which diabetics are hitting their targets and which ones are heading for kidney failure. Show me if I'm making or losing money on my Medicare contracts.

Who Benefits Most from Care Management Solutions?

Care Management Solution platforms work best for practices with lots of Medicare patients or those in ACO contracts. If you're getting paid based on patient outcomes rather than visit volume, you need these tools.

Family doctors get hit hardest because they're supposed to manage everything their patients have wrong with them. Hospitals want to stop patients from coming back within 30 days because Medicare won't pay for it.

If you treat lots of diabetics, heart patients, or people with breathing problems, you need this. These patients call constantly and show up in the ER when things go bad. Community health centers deal with patients who can't afford medications or don't have transportation to appointments.

Measuring Success with Care Management Platforms

The success? It's fewer emergency room visits, fewer hospital readmissions, and patients who actually take their medications and show up for appointments.

Track these numbers:

• Patient Outcomes: Are your diabetics keeping their A1C under control? Are your heart failure patients staying out of the hospital? Are patients filling their prescriptions?
• Financial Results: Are you meeting your quality benchmarks? Are you getting bonus payments from Medicare Advantage plans? Are you avoiding readmission penalties?
• Staff Productivity: How many patients can each care manager handle effectively? Are patients responding to outreach attempts? Are care plans getting completed?

Takeaway 

Value-based care isn't going away. Practices that figure out how to manage patients between visits will succeed. Those who don't will lose money on every Medicare and insurance contract. Care management platforms give you the tools to track patients, prevent problems, and prove you're delivering quality care.

Persivia offers platforms that help practices track high-risk patients and coordinate care across your entire network. Our tools work with your existing systems to reduce readmissions and improve quality scores.

MIPS Value Pathways Explained: A Simplified Approach to Reporting

MIPS reporting hits every medical practice the same way. You spend weeks picking measures, your staff scrambles to collect data, and you still don't know if you chose right. MIPS Value Pathways address this issue by grouping related measures in a way that makes clinical sense.

You work on one focused area instead of jumping between random quality measures that have nothing to do with each other.

What Are MIPS Value Pathways?

MIPS Value Pathways are groups of measures that go together. If you treat a large number of diabetic patients, you select the diabetes pathway. If you run an ER, you pick the emergency medicine pathway.

Here's what you get in each pathway:

• Quality measures targeting specific conditions or populations
• Improvement activities that reinforce those clinical areas
• Cost measures relevant to the pathway's focus
• Promoting Interoperability requirements

This structure eliminates the guesswork involved in selecting compatible measures across different MIPS categories.

How Do MIPS Value Pathways Simplify Reporting?

MIPS Value Pathways reduce the complexity of measure selection and coordination. Practices choose one pathway that matches their clinical focus rather than researching individual measures across categories.

The pathway structure ensures measures complement each other clinically. Quality measures align with improvement activities, creating coherent quality improvement initiatives rather than scattered compliance efforts.

Administrative time decreases because staff focus on one coordinated set of requirements. Quality Reporting becomes more clinically meaningful when measures connect to daily patient care activities.

Which MIPS Value Pathways Are Available?

CMS picked six areas they care about most:

• Emergency Medicine: Patient safety and best practices
• Diabetes Care: Managing blood sugar and complications
• Infectious Disease: Antibiotic stewardship and infection control
• Heart Disease and Stroke Prevention: Cardiac risk management
• Musculoskeletal Care: Rehab and physical therapy support
• Mental Health and Substance Use: Behavioral health treatment

Who Should Consider MIPS Value Pathways?

Practices serving concentrated patient populations benefit most from MIPS Value Pathways. Specialty practices often find pathways more clinically relevant than traditional MIPS measure combinations.

Primary care practices managing significant volumes of patients with chronic conditions like diabetes or cardiovascular disease see clear advantages. Emergency departments and mental health practices can align their quality efforts with their clinical expertise.

Smaller practices appreciate the reduced research burden since pathway measures are pre-selected and coordinated.

How Do You Select the Right MIPS Value Pathway?

Evaluate your patient demographics and clinical strengths when considering MIPS Value Pathways. The pathway should match your practice's actual patient care activities.

Look at what you do every day:

• Patient Mix: What conditions do you see most?
• Practice Focus: Are you a specialist or treat everything?
• What You Already Track: Do you already measure things in this area?
• Your Team: Can your staff handle the extra work?

If none of the pathways match what you do, stick with regular MIPS.

What Are the Advantages of MIPS Value Pathways?

MIPS Value Pathways offer distinct benefits over conventional MIPS Reporting approaches:

Reduced administrative overhead occurs when staff focus on one coordinated pathway rather than managing disconnected measures. Clinical coherence improves because measures support unified quality improvement goals.

Performance scores often benefit when measures reinforce each other rather than competing for resources and attention. Staff education becomes more focused and effective.

Bottom Line

MIPS compliance requires strategic thinking about quality measurement and reporting. Value pathways provide a more organized approach that connects quality requirements with clinical priorities.

Practices that align with available pathways can reduce administrative burden while creating more meaningful quality improvement initiatives.

Transform your MIPS reporting approach today. Persivia offers platforms that support value pathway reporting and quality measurement coordination. Our solutions help medical practices streamline compliance requirements while focusing on patient care improvements that matter.

Value-Based Care: Shifting Focus From Volume To Value

Healthcare payment has always rewarded doctors for doing more. They do more tests, more procedures, more visits, and ultimately get paid more. Value-Based Care pays providers for keeping patients healthy, rather than paying for procedures. When hospitals are paid for achieving good outcomes rather than simply maintaining busy schedules, patient care improves and costs decrease.

What is Value-Based Care?

Value-Based Care pays healthcare providers based on how well their patients do, not how many services they provide. A doctor who prevents heart attacks earns more than one who treats them after they happen. It’s basically a proactive approach. 

The old payment system worked like this:

• Order ten blood tests, get paid for ten tests
• Send patients to five different specialists, bill five times
• Keep someone in the hospital an extra day, make more money
• Perform surgery, receive a large payment

How Does Value-Based Care Work in Practice?

Hospitals and doctor groups sign contracts that align their payments to patient results. If patients get better care and stay healthier, providers ultimately earn extra. If quality drops, they lose their revenue.

Payment arrangements include:

• Shared savings, where providers keep half of any money they save
• Fixed payments that cover everything a patient needs for a year
• Bonuses for hitting quality targets like vaccination rates
• Penalties for issues like infections or readmissions

VBC Benefits For Patients

Patients get good care because their doctors spend more time examining and treating them rather than being concerned about their monetary gain. 

Patients see improvements like:

• Longer appointments with more personalized attention
• Better communication between their different doctors
• Doctors focus on stopping illness before it starts
• You pay less for checkups and preventive care
• Fewer errors because of better coordination

Value-Based Care Implementation

Top value-based care companies know both the medical side and the business side of healthcare. They help hospitals and doctor groups navigate new payment rules while still providing excellent patient care.

Leading value-based care companies offer:

• Software that predicts which patients will get sicker
• Systems that help coordinate care between different doctors
• Tools that track quality measures for insurance reporting
• Analytics that show whether value-based contracts are profitable

These companies understand that switching to value-based care requires new technology and new ways of working.

What Technology Do Providers Need for Value-Based Care?

Value-based care solutions need to connect patient health information with financial data. Doctors need to see both how their patients are doing and whether they're meeting their contract goals.

Key technology features:

• Alerts that identify patients at risk for complications
• Reminders about missing preventive care, like mammograms
• Cost tracking for each patient's complete treatment
• Automated reporting for insurance company requirements
• Dashboards that show population health trends

The technology should help doctors make better medical decisions while meeting business requirements.

What Challenges Do Providers Face?

Most providers struggle because their systems were built for the old payment model. Common problems include:

• Different computer systems that don't share information
• No way to track quality measures across all patients
• Staff who resist changing how they work
• Cash flow problems during the transition period
• Difficulty predicting which patients will cost more to treat

Success requires new systems, staff training, and patience during the transition.

Making Value-Based Care Work

Healthcare payment is changing, but doctors need better tools to track outcomes and manage contracts. The switch requires technology that tracks both patient health and contract performance.

Persivia offers value-based care solutions that help healthcare organizations succeed in outcome-based payment models. Our platforms connect patient data with financial performance so providers can deliver excellent care while meeting contract requirements. We help healthcare organizations focus on patient outcomes while maintaining financial health.

Population Health Analytics: From Data To Measurable Impact

Hospitals collect patient data all day long, but rarely know what to do with it. Population Health Analytics fixes this problem by showing hospitals which patients need help and when. You catch health issues before they turn into expensive emergencies.

What is Population Health Analytics?

Population Health Analytics studies health trends in patient groups. You examine hundreds or thousands of patients to identify patterns, rather than waiting for individual problems.

The process works in 3 steps:

• Get information from medical records, insurance claims, and lab results
• Find patterns that show which patients need help
• Create plans to help those patients before they get sicker

This beats the old way of waiting for people to show up sick.

How Does Cost Utilization Analytics Work?

Cost Utilization Analytics tracks where healthcare money goes and finds waste. It shows which treatments work and which ones drain budgets without helping patients.

Hospitals use this data to spot problems like:

• Patients who visit the ER for routine care
• Doctors ordering unnecessary tests
• People skipping medications and ending up hospitalized
• Expensive treatments that don't help patients more than cheaper options

Hospitals use this information to change how they treat patients.

What Features Should Population Health Analytics Software Include?

Good population health analytics software needs to handle messy healthcare data from different systems. 

Must-have features:

• Connects to your current medical records system
• Spots high-risk patients automatically
• Predicts which patients will get sicker
• Shows gaps in preventive care
• Proves which programs save money

Doctors and nurses need to understand the data without taking a computer science course.

Which Companies Lead Population Health Analytics?

The best population health analytics companies know healthcare inside and out. They don't just sell software. They understand how hospitals actually work.

Top companies offer:

• Systems that grow with your hospital
• Smart algorithms that learn from your data
• Help with meeting government reporting requirements
• Training that gets your staff up to speed fast

What matters most is finding a company that makes your data useful, not just pretty.

How Do Organizations Measure Success?

Success comes down to two things: better patient care and lower costs. Hospitals track specific numbers to see if their analytics programs work.

Key metrics include:

• Fewer patients are coming back to the hospital within 30 days
• Less crowded emergency rooms
• Better control of diabetes and heart disease
• Lower costs per patient
• Happier doctors and nurses using the system

The best programs improve several areas at once.

Implementation Challenges

The biggest problem is that hospital data lives in different places that don't talk to each other. Your lab system doesn't connect to your billing system, and neither connects to patient records.

Other common problems:

• Old computer systems that resist change
• Messy data that needs cleaning up first
• Staff who don't want to learn new tools
• Not enough IT people to manage everything
• Budget fights over new technology

Success requires planning and patience. Rush the process and you'll create more problems.

Transform Your Population Health Strategy With Persivia

Healthcare data can save money and save lives. You just need the right software and a plan that works. Persivia builds population health analytics platforms that work in real hospitals with real problems. We focus on results that matter: healthier patients and sustainable finances.

Get in touch today.