Original article By Michael Choo, M.D., MBA, FACEP, FAAEM, CMRO, Paradigm https://www.biausa.org/public-affairs/media/engaging-payers-and-insurance-groups
Opinions provided by Dr. Karen Rosenberger, Director of NeuroRehabilitative Services at Success Rehabilitation.
How can a brain injury care provider best demonstrate to payers the value of rehabilitation services?
To best deliver on superior value and outcomes, rehabilitation providers should:
First: Partner with payers to determine and standardize clinical outcome measures that are truly meaningful to patients and payers.
Dr. Karen Rosenberger, Success Rehabilitation: We strongly agree with this recommendation. Outcome measures selected need to reflect changes in patient functioning on a day-to-day basis. Clinicians must hear what matters to each individual, and always need to be able to answer the question: “How will this therapy make my patient’s life better?”
Second: Focus on analyzing the actual impact of each treatment modality and ascertain through scientific evidence what the “sweet spot” dosages are for achieving incremental and maximal benefit and for determining the highest therapy associated return on investment.
Dr. Karen Rosenberger, Success Rehabilitation: Outcome measures can gradually be incorporated into clinical practice and begin with conversations about what is progress, how can we measure progress, and what measures are cost-effective and meaningful to examine. It has taken some time to comprehend that there is truly no “perfect outcome measure”. We started with quarterly measures for each discipline that will inform decisions about whether this specific discipline’s intervention is indeed cost-effective to provide at the current level of intensity.
Third: Rehabilitation providers must be willing to work with payers on outcomes-based comparative effectiveness measures of new versus existing rehabilitation interventions.
Dr. Karen Rosenberger, Success Rehabilitation: Rehabilitation teams benefit from being encouraged to attend Continuing Education opportunities, to read the research and to be creative in their approach to determine what innovations can potentially make a difference to their patients.
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