SIOUX CITY | Expect to receive more phone calls from your primary physician's office in 2016.
Lynn Wold, president and CEO, of UnityPoint Health-St. Luke's, said providers need to take care of all a patient's needs from A to Z in order to receive reimbursement from the Centers for Medicare & Medicaid Services (CMS).
"I don't think there's anything earth-shattering coming forward," he said of health care in the New Year. "It's really fine tuning this process of care coordination and value-based purchasing in health care."
For years, CMS reimbursed providers based on the number of visits and tests they ordered. That model is known as fee-for-service. Times are changing. CMS is now shifting to a value-based payment system, where providers are reimbursed based on the value of care they provide.
The U.S. Department of Health and Human Services (HHS) has set a goal of tying 30 percent of Medicare fee-for-service payments to quality or value through alternative payment models by 2016 and 50 percent by 2018.
"Theoretically, the more volume you do, the more successful you are. That's kind of the old-school measure. We'd measure admissions, surgical procedures, lab tests, clinic visits," Wold said. "Going forward, we measure success by how well we are caring for these groups of patients."
Are patients managing their diabetes or high blood pressure? Are they coming in for checkups every three months if needed? These are the kinds of questions, Wold said providers have to be asking themselves.
"If the patient is non-compliant, that's our risk," he said.
Care coordinators play an important part in health care reform. They work closely with primary care providers and patients with the goal of helping the patient better understand their condition and ensure that they receive the care that they need. Coordinating patient-care services reduces costs by keeping people with chronic conditions out of the emergency room.
"What we're trying to prevent is them to have an acute episode because they missed their routine checkup," Wold said.
Home care providers, Wold said, also play an important role in preventing hospital readmission. Medicare covers the cost of home care services for people who are homebound or those who have difficulty leaving their residences safely.
Studies show that nearly half of all hospitalizations involving seniors can be prevented. Home care aides can assess a patient's risk for falls and devise a plan to prevent them through physical therapy or home modifications.
MORE VIRTUAL VISITS
Wold expects the use of virtual health care services, which many companies introduced employees to this fall, will grow in the next year.
On June 2, UnityPoint Health launched Virtual Care, in collaboration with MDLIVE, the nation's largest network of board-certified telehealth doctors. Virtual Care allows patients over the age of 3 to connect with a physician anytime, anywhere for a doctor's visit by phone or secure online video.
The service is designed for patients with minor illnesses, such as ear infections, cold and flu, rashes, sore throats, headaches, allergies and urinary tract infections. For $49, a patient can obtain a diagnosis and prescription from a physician via computer or smartphone. You don't have to be a UnityPoint Clinic patient to use the service.
"That's something that's very relevant and will continue to grow," he said.