Value-Based Healthcare And The Relevance Of Medical Records Review

by | Published on Sep 12, 2022 | Medical Record Review

The value-based healthcare model prioritizes three aspects – improving the quality of care, refining the patient experience, and reducing healthcare costs. This model is advantageous in that it increases patient safety and patient satisfaction. Medical records review is an important consideration in value-based care delivery because it is the main method to keep track of the healthcare services provided to the patients and their outcomes. In this system, providers are incentivized to focus on improving safety measures and patient outcomes. To determine the “value,” the improved healthcare results are compared to the patient care costs necessary to achieve such outcomes.

Medical Records and Medical Record Review Are Crucial

Accurate review of the medical charts of patients will provide the medical evidence needed to ensure optimum care and value. This information enables providers to better manage disease, and improve the health of patients suffering from chronic conditions through evidence-based medicine. Healthcare entities can meet their voluminous medical record review needs by enlisting the services of a medical review company.

  • The evidence needs to be extracted from the relevant medical records.
  • It helps minimize duplicate services and focus more on population health management and make clinical decisions based on concrete medical evidence.

The value-based care model helps providers give their opinions on advanced technology such as patient portals. Moreover, it helps them encourage shared decision-making with patients who are on end-of-life treatment or care. Value-based care can also help reduce costly readmissions.

The new healthcare model can improve engagement between healthcare providers and their patients. This is important because patients who are actively involved in their care are more likely to stick to the prescribed treatment plans, keep track of their health, and clear any concerns they may have with their providers.

What Medical Records Are Reviewed?

Medical records contain all details about a patient’s health, what treatments they have undergone, what medications they take and what they are allergic to, and other important data. This is why it is important for providers to ensure that the medical charts of patients remain consistent and accurate over time. Whether paper or electronic, medical records generally include the following:

  • Handwritten notes from treating doctors
  • Tests and lab results
  • Imaging results
  • Consent forms
  • Printouts from monitoring devices, if any

Apart from these, communication in the form of emails between the doctor and the patient, or among the members of the care team. Medical record review will bring out information that is most important for the doctor, patient, and any other person involved in patient care. Since accuracy is crucial in a medical record, providers can benefit immensely from having a medical review firm evaluate the records.

Medical records and their review are important because of the following reasons.

  • The medical record informs the doctor: The patient’s medical chart contains information regarding all their medical encounters, and provides the basic information the doctor needs without having to ask any questions to the patients. Also, accurate medical records are vital when a patient needs to be cared for by another doctor or a specialist.
  • Medical records are important from the viewpoint of medical billing: Review of medical records is important to get information on what treatments will be covered by health insurance. Payers also perform medical record review to move the claims processing forward.
  • Medical records are vital to safeguard the patient’s health: Medical records provide a summary of the patient’s treatment plan. It is based on this documentation that the patient’s prognosis is made. The medical chart gives details of the medications the patient is allergic to, and prescribed medications that cannot be mixed with others.
  • Accurate medical records protect the provider against any legal risk: Well-maintained medical records and accurate review of these documents could help providers build a strong defense in case there is a malpractice lawsuit filed against them or the healthcare facility.

A Medical Review Company Ensures Organized Medical Records

In any healthcare model, including value-based care, patient medical records are very important. Medical review companies and medical peer review companies provide valuable service in this context, ensuring a comprehensive and complete collection of the required medical records. For hospitals and healthcare systems, detailed and properly organized patient records are vital to ensure proper treatment to their patients.

With a comprehensive medical record audit, these healthcare entities can review the patient data easily and also identify missing documents or gaps in the documents, which are important to ensure quality treatment and optimal patient safety. The transition from fee for service to the value-based care model is expected to provide better health outcomes. The electronic health record, multidisciplinary care teams, and evidence-based data will help providers care for patients across all health concerns and care environments. With improved health outcomes, the healthcare sector overall would perform more efficiently, with lesser medical emergencies and hospitalizations, and enhanced patient experience and satisfaction.

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