In the dynamic realm of healthcare, the winds of change are ushering in an era marked by increased transparency, positioning it as a cornerstone of value-based care (VBC). This shift not only enhances accountability but also plays a pivotal role in elevating the quality of care and steering toward meaningful outcomes.

The impact of transparency is evident in recent healthcare policies and regulations. President Biden’s Nursing Home Ownership Disclosure Rule, enacted by the Centers for Medicare & Medicaid Services and the Department of Health and Human Services on Nov.15, 2023, stands as a transformative measure, illuminating ownership structures and fostering transparency that holds nursing homes accountable for the quality of care. 

Simultaneously, CMS initiatives for hospital transparency (began Jan. 1, 2021) and health plan coverage transparency (began July 1, 2022) empower patients with vital information, fostering competition among providers and thereby improving the overall quality of healthcare services.

The legislative landscape further reflects this paradigm shift with the introduction of the Lower Costs, More Transparency Act (H.R. 5378). This bipartisan bill mandates healthcare providers and insurance providers disclose specific information about health costs, establishing vital requirements for payment methodologies under Medicare, Medicaid and other public health programs.

In the same vein, the long-term care proposed rule (Sept. 1, 2023) included minimum staffing standards for LTC facilities and Medicaid institutional payment transparency reporting, which aims at establishing nursing staffing requirements to promote accountability and yield high-quality care.  

While the proposed rule comes with notable concerns as the industry experiences continued severe staffing struggles, the same thematic trend prevails across each regulatory move – increased transparency is here to stay. 

The question then becomes, with a greater focus on value-based care alongside visible accountability, how do you set the stage for success? Here are five strategic moves for consideration. 

  1. Purposeful shifts to foundational work flows are critical in order to align with dynamic market changes, characterized by rising post-acute needs. 
  2. Today’s evolving clinical demands require the expansion of roles and responsibilities among healthcare providers. Each team member must possess a deep understanding of the critical nature of their role in addressing the complex needs of patients while also being held accountable for their contributions towards achieving this collective goal.
  3. Expanding the care team to include specialty service providers is pivotal for delivering robust, comprehensive care to patients with varying complexities. This coordination of care is essential in an environment where transparency and accountability stand as key requirements. 
  4. Leveraging technological advancements, including telehealth services and remote monitoring capabilities, allows for accessible, equitable care from providers and is often overlooked.
  5. Other diversification initiatives gaining significant momentum are related to innovative payor models and risk-sharing methodologies, such as episodic and global capitation payment models, the Making Care Primary Model, and ACO REACH + ISNP expansions. While each program and payor innovation has different specificities, the participant goal of expanding provider impact resulting in efficient outcomes that transform healthcare delivery remains the same. Exploring diversification in the innovative payor space has become a cornerstone for achieving success in the value-based care paradigm.

As the healthcare sector experiences a seismic shift towards transparency, the marriage of transparency and diversification emerges as a powerful force. 

The trajectory toward value-based success is clear: leverage transparency as a foundation and embrace diversification as the key to unlocking the full potential of collaborative, quality-driven healthcare. In doing so, we not only navigate the current landscape but also pave the way for a future where transparency and diversification become synonymous with excellence in healthcare delivery.

Erin Dunn, MS, CCC-SLP, RAC-CT, is the VP of Strategic Partnerships for HealthPRO Heritage.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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