A New Approach to Value-Based Care: Diagnostically Connecting Data and Diagnoses

The conventional transactional method of coding diagnoses for billing in a fee-for-service setting falls short in meeting the care needs of value-based care (VBC) programs. Effective management of patients' chronic conditions and prevention of complications, such as hospital readmissions and costly interventions, are key objectives of Medicare Advantage (MA) and other VBC programs. To ensure accurate compensation for providers, VBC programs rely on clinical risk scores derived from patient diagnoses. A more robust approach is necessary, empowering providers with the necessary information and tools to effectively manage patient care within VBC programs.