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Introducing the ValueSCORE™ Ratings System

Updated: Sep 26, 2023

Healthcare organizations face daunting challenges in delivering high-value care to their patients, while generating revenue sufficient to meet the costs of such care. As the country emerges from the COVID-19 crisis, the industry has renewed its attention to the shift from volume to value-based payment for services. In addition, payors, including Medicare, have begun to tie payment to initiatives promoting health equity. In order to adapt to the changing landscape, new tools are required to give providers the information needed to measure and develop actionable strategies for pursuing value-based care. We at InHealth Advisors developed the ValueSCORE™ ratings system to empower healthcare organizations with the analytics necessary to assess readiness and implement effective strategies to further value-based care. This Insight InHealth will introduce and explore the ValueSCORE™.


New Challenges Faced By Healthcare Organizations


The reimbursement landscape is evolving. While the majority of payments are made through fee-for-service payment systems, payors are applying pressure on healthcare providers to increase the degree of their reimbursement at-risk based on the quality and cost of care delivered. Furthermore, ongoing research has demonstrated that overall health is heavily impacted by the underlying social conditions present in the lives of patients; as a result, payors are setting the stage for tying payment to care that integrates the social determinants of patients’ health. Finally, and relatedly, payors are exploring ways to incentivize providers to improve the health equity of their beneficiaries.


With these myriad challenges, novel tools are needed to empower organizations with the information necessary to strategically plan for and deliver high-value healthcare.


ValueSCORE™ - An Innovative Ratings System


With these challenges in mind, we have developed the ValueSCORE™ ratings system. Our initial use case for the ratings system is acute care hospitals. ValueSCORE incorporates over 80 data points from five key domains of health care delivery, to provide a single, meaningful quantification of the value of care delivered by over 3,300 acute care hospitals in the US. Unlike other ratings systems, ValueSCORE™ accounts for the change in performance over time while adjusting scores to account for the underlying social risk of the populations treated by hospitals. The combination provides an unprecedented resource for accurately capturing the value of care while accounting for social determinants of health.


The five domains of value were selected based on their current and future use in reimbursement systems that put dollars at risk. The domains are presented below and are summarized by the acronym, SCORE:


The “SCOE” domains (Safety, Cost, Outcomes, and Engagement) are used to evaluate the performance of hospitals both in the current and prior period. The scoring for these domains is adjusted upwards if facilities have demonstrated improvement over time, and vice versa. Furthermore, facilities receive a bonus to scoring as the number of reported metrics increase. For its overall ValueSCORE™, every facility receives a score between 0 and 100, corresponding to the percentile of performance; each of the five domains of value is scored similarly.

The ValueSCORE™ incorporates an innovative method for adjusting the SCOE domains to account for the social risk of treated patients. The “Risk” domain tracks the social determinants of health for the patients in each hospital’s primary service area. The lower the degree of risk associated with the social determinants of health, the higher the expectation of scores in the SCOE domains. Using linear regression, we estimate a line of best fit for performance across the SCOE domains based on the risk score for each hospital’s service area. Facilities receive a higher score if their performance in the SCOE domains exceeds the estimated score based on their level of risk, while the score is reduced if performance falls below the trend line.


The social risk adjustment creates a measure of value that puts facilities on a level playing field to best understand the overall value of care delivered to patients. The ValueSCORE™, found at www.myvaluescore.com, is web-based for convenient access. All users receive FREE access to the scoring of a facility of their choosing. This score, called MySCORE, details the overall ValueSCORE™ for the facility, along with scoring across the five separate value domains.


For a much greater level of detail, users can purchase access to ValueSCORE™ Gold, which provides access to many features, including:

Benefits of ValueSCORE™


The ValueSCORE™ ratings system provides a myriad of benefits to users. Below, we summarize three of the most pressing and actionable benefits for acute care hospitals.

Reimbursement Negotiations

Demonstrating the value of healthcare is notoriously difficult, and complicated by the competing interests that arise in a third-party payment system. An extra dollar of reimbursement to a provider is a potential dollar pulled from the bottom-line of a payor or another dollar increase to the premiums of insurance consumers. Accordingly, healthcare organizations are increasingly put in the position to demonstrate the value of their care to be reimbursed sufficiently for their services. The ValueSCORE™ system provides a one-stop resource for evaluating performance across the five domains, providing a dense and streamlined presentation of the value of care.


As research has demonstrated, overall health is heavily driven by factors that fall outside of the direct care provided by healthcare practitioners. This relationship has driven payors and providers to address the social determinants of health for their patients. To date, healthcare rating systems have not incorporated meaningful adjustments to account for the underlying social risk of patients in primary service areas. ValueSCORE™ represents the first ratings system to adjust measures of value to account for the varying social risks in marketplaces across the country. With this information, hospitals can provide an objective basis for establishing the value of care on a level playing field.

Improving Health Equity

A rare point of unanimity in the industry, both payors and providers increasingly recognize the importance of addressing substantial inequities in the access to, quality and cost of healthcare. The ValueSCORE™ gives users a detailed understanding of the social determinants of health within their primary service area. ValueSCORE™ Gold gives users the extensive insight into the Risk domain of value, which includes detail around the 15 social risk metrics applicable to every evaluated hospital. The metrics detail topics such as socioeconomic status and health behaviors within the primary service area. This data can assist hospitals in developing targeted strategies to mitigate inequalities arising from the social determinants in their marketplace.


Furthermore, hospitals seeking to incentivize their employed and contracted providers to direct care to vulnerable populations can incorporate the Risk data from the ValueSCORE™ platform into provider compensation plans. For example, hospitals that employ primary care practitioners under panel-based compensation models can utilize the data to perform social risk-adjustment of panel size. Provider compensation plans that reward steps to address health equity will be crucial to ensure alignment for mission-driven organizations and with payors seeking to mitigate inequities.


Futureproofing

As more payors expand reimbursement models that seek to hold providers accountable for the cost and quality of care, healthcare organizations must have strategic plans in place to future-proof their organizations from potential declines in reimbursement. The ValueSCORE™ ratings system was developed by experts in value-based care to provide the information necessary for busy executives to quickly identify deficiencies and areas of improvement. The ValueSCORE™ Gold platform allows users to develop peer-group comparison s across 16 different dimensions to enhance competitive business intelligence. The ValueSCORE™ ratings system provides hospitals with the information needed to stay ahead of the curve.


Summary


With the ValueSCORE™ ratings system, hospitals now have a consolidated platform to quickly and thoroughly understand the value of care in a manner tailored to address the changing strategic landscape within the industry. The innovative social risk adjustment methodology yields unprecedented insight into the value of care. Furthermore, the robust features of ValueSCORE™ Gold enable hospitals to perform effective strategic planning to adapt to changing reimbursement models and mandates to redress health inequities.


You are one click away from being able to explore your free MySCORE and continuing on the journey to make value-based care a reality.



Introducing the ValueSCORE Ratings System
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Works Cited

[1] Centers for Medicare & Medicaid Services Innovation Center, Driving Health System Transformation - A Strategy for the CMS Innovation Center’s Second Decade (October 20, 2021), accessible at: https://innovation.cms.gov/strategic-direction


[2] Centers for Medicare & Medicaid Services Press Release, "CMS Outlines Strategy to Advance Health Equity, Challenges Industry Leaders to Address Systemic Inequities" (April 20, 2022), accessible at: https://www.cms.gov/newsroom/press-releases/cms-outlines-strategy-advance-health-equity-challenges-industry-leaders-address-systemic-inequities


[3] Harvard T.H. Chan School of Public Health (Amy Roeder), "Zip code better predictor of health than genetic code" (August 4, 2014), accessible at: https://www.hsph.harvard.edu/news/features/zip-code-better-predictor-of-health-than-genetic-code/



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