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Last year, CMS set an ambitious goal: to have 100% of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships, a type of value-based care model, by 2030. Considering more than 66 million people are enrolled in Medicare and 80 million are enrolled in Medicaid, that’s nearly half of the entire U.S. population.
It’s an admirable goal, but the reality is value-based care is difficult to execute for both health plans and providers. Significant roadblocks, including- financial obstacles, lack of organizational readiness, and poor data integration, exist that unintentionally deter health care professionals from delivering value-based care as consistently as they may want to. For example, take medical records, which are complex and contain vast amounts of structured and unstructured data. In the context of value-based care, precise coding of this complicated data, which has historically been time consuming to analyze, is essential for delivering quality patient care, to achieve accurate rating scores like HEDIS, and secure fair reimbursements. The shift from CMS-HCC Model V24 to V28 will require even greater specificity in documentation and code assignment to ensure the accurate level of Medicare Advantage patients’ illness severity is captured.