CAQH identifies key opportunities to improve value-based care

A stethoscope on a computer keyboard
CAQH CORE identified key areas where improved collaboration and development of industry standards could ease implementation of value-based payment methods. (Getty/anyaberkut)

There are plenty of barriers stand that stand in the way of implementation to value-based care. But a new report suggests better industry collaboration around certain targets, such as more uniform data standards, could greatly accelerate progress.

In the new report, nonprofit health technology group CAQH CORE said it sees parallels in the problems the industry saw as it began to use electronic transactions in fee-for-service transactions.

Since value-based payment models seek to shift provider incentives to improve care quality and reduce cost, they require new approaches to measuring and reporting data. But as healthcare organizations feel pressure to shift from fee-for-service payment models toward value-based ones, operational headaches around implementation often cause them to hesitate or resist.

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CAQH CORE set out to study the operational processes currently required to implement value-based payment models with an eye toward opportunities to streamline the exchange of that information. Those opportunities included: 

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  1. Uniform data standards: Irregular data, or data used inconsistently among stakeholders, reduces the utility of the information and could cause misinterpretation.
  2. Improved interoperability: The group identified a lack of interoperability among systems as a key problem and recommends improved coordination on the development of standards and best practices.
  3. Consistent risk assessment methods: Balancing quality and cost require providers to assess which patients are at high risk to improve outcomes in a process called risk stratification. But there is a the lack of uniformity or transparency of how health groups assess risk.  
  4. Consistent attribution models: The report found a range of attribution models in place across health plans, making it difficult to identify which provider has responsibility for certain patient populations.
  5. Consistent quality metrics: The metrics by which the industry measures provider quality have continued to grow, leading to increased data-collection and reporting burdens for providers. The report suggests large-scale industry players such as CMS improve harmonization of quality measures to reduce the burdens practitioners face.