The Executive Suite: Take the anxiety out of end-of-year, value-based care gap closure

The end of each calendar year brings with it an atmosphere of heightened scrutiny for risk-bearing health care organizations. These organizations are in a race against time to close risk and quality gaps to maximize their performance and reimbursements in value-based care (VBC). The upcoming Healthcare Quality Week is a timely reminder for organizations to monitor their key performance indicators and to advance patient care initiatives with the goal of finishing the year on a high note.

Two categories of VBC organizations

Organizations engaging in VBC generally fall into two categories: Those well-versed and deeply embedded in VBC practices and newcomers still exploring the terrain. Experienced organizations are often at ease as the year winds down; they have the advantage of data-driven insights that allow for proactive gap closure. New entrants, however, may struggle to align limited resources with ambitious goals, resulting in end-of-year fire drills that could be avoided through a more proactive, year-round approach.

A foundation for success

The first step is ensuring providers have access to validated and trustworthy data, seamlessly integrated into their workflows. Actionable insights drawn from quality, risk, and gap analyses are indispensable for clinicians who are already pressed for time. For instance, risk adjustment programs necessitate comprehensive documentation, particularly for chronic conditions that require ongoing assessment.

Designing a clinical document improvement program with the goal of appropriately capturing the risk of your population is akin to orchestrating a symphony—you need coordination among clinicians, coders, management, and other key stakeholders. Start with the basics—Who, What, When, Where, Why, and How. Appoint a physician champion at each practice to lead the planning and implementation, engage stakeholders early, and establish a culture of continuous quality improvement. The support of executive leadership is critical, as is buy-in by operations teams, ensuring that physicians have the support they need to deliver on program goals.

How patient engagement can support year-end goals

A year-round, “always on” patient engagement strategy is the other pillar for success in VBC. An effective patient engagement strategy is team-oriented, specific, and customized to the patient’s unique needs. Having the tools to tailor patient outreach and utilize fast, customizable communication methods like text messaging can significantly enhance care teams' ability to engage patients.

Successful risk-bearing organizations use outreach campaigns to pair timely, data-driven messaging with links to patient charts and portals, and even resources for social service needs. Some of the most common text messages that organizations send as part of their patient engagement efforts include campaigns to close gaps around immunization, well visits, preventive care like mammograms, and management of chronic conditions like diabetes and hypertension.

While it’s best practice to include these tactics in a year-round strategy to help close gaps and meet crucial year-end goals they can also be incorporated into one-off campaigns. For example, organizations in areas that experience natural disasters, such as wildfires, can send alerts warning patients about unhealthy air and sharing prevention tips to avoid unnecessary visits to the emergency department.

The crucial role of data in year-end success

As we navigate the rapid changes in health care—ranging from digital innovations to sweeping payment reforms—the margin for error in meeting performance targets is razor-thin. Especially in the second half of the year, it’s crucial to stay on track or make necessary adjustments to ensure a strong finish.

To prepare for this volatile landscape, organizations must leverage advanced technologies to create a unified data ecosystem that enhances both care delivery and financial sustainability. In the era of value-based care—especially with CMS’ goal of having all beneficiaries under value-based agreements by 2030—data and technology aren’t just support tools, they are the currency of modern health care.