The Health Effectiveness Data And Information Set ( Hedis )

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The traditional primary care and FFS models rewarded clinics for the volume of care provided. The more patients seen and services provided, the more productive and profitable clinics were. Primary care clinics will need to find new ways to measure productivity as payment models shift their attention from volume to value. Therefore, the Belvoir Primary Clinic will measure the clinics productivity not on the number of patients seen but on the outcomes of the care provided and its financial efficiency. The clinic will assess outcomes of care by using the Health Effectiveness Data and Information Set (HEDIS). This set of 81 measures captures how well the clinic meets quality criteria within five domains of care. Some areas of focus are access to care, utilization of services and delivery comprehensive (“Measuring performance”, n.d.). The HEDIS measures will allow the Belvoir Primary Care Clinic to determine the quality of care provided. Through analysis of this data the clinic will conclude if the resources needed to support the services such as the triage line and same day acute appointments actually reduce the emergency room and hospital usage. If the programs are indeed reducing utilization rates then the clinic could qualify for additional payments and incentives through special programs. Similarly, if HEDIS metrics show that the clinic is performing well in caring for patients with chronic illness, it validates the effectiveness of care coordination services and nurse and provider productivity. In the value-based payment model outcomes drive reimbursement therefore the ability to capture the care provided and bill for this care is paramount. Providers must demonstrate proficiency in documenting and coding visits so that the pr... ... middle of paper ... ...and he stands with us always. Conclusion There are many factors that influence the management of financial, material, and personnel resources within a PCMH. Organizational leaders must understand that changing payment models, complex coding methodologies, as well as unclear staffing requirements present unique financial and operational challenges. Staying abreast of healthcare reforms will allow leaders to identify new revenue streams, achieve more meaningful returns on investment, and maintain the financial viability of their organizations. Furthermore, promoting an organizational culture that values quality, safety, and efficiency not only improves patient outcomes but also encourage employee retention and recruitment. Finally, effective and active leadership as well as well a well-defined strategic plan are essential to the successful implementation of PCMH.
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