Driving Compliance with Value-Based Care Models: How Patient-Reported Outcomes Elevate Healthcare Quality

By Jessica Rains, Director of Customer Success & Marketing, OutcomeMD

The shift to value-based care (VBC) has become a cornerstone of healthcare transformation. Policies like the Medicare Access and CHIP Reauthorization Act (MACRA) are fundamentally reshaping how providers and hospitals operate, prioritizing patient outcomes over service volume. While the transition promises better care and cost savings, it also comes with significant challenges, especially regarding compliance with reporting requirements under models like the Merit-based Incentive Payment System (MIPS).

One crucial enabler of compliance—and a potential game-changer for healthcare providers—is the use of Patient-Reported Outcome Measurements (PROMs). By integrating PROMs into care delivery, healthcare providers can not only meet regulatory requirements but also drive improved care outcomes and enhance patient engagement. As the industry accelerates its adoption of value-based care, these insights highlight the role of PROMs as a transformative tool.

The Growth of Value-Based Care: Industry Trends and Challenges

Healthcare spending in the U.S. has reached unprecedented levels, with CMS estimating national health expenditure to exceed $6.2 trillion by 2028. To control costs and improve care, value-based payment (VBP) initiatives now account for 59% of healthcare payments in the U.S., according to a report from the Health Care Payment Learning & Action Network (LAN). These programs focus on incentivizing providers to achieve better outcomes for patients rather than performing more procedures.

The incentives under VBP programs are clear: better health outcomes lead to improved reimbursement rates. However, achieving compliance with frameworks like MIPS remains a pain point for many providers. A 2022 Deloitte survey of healthcare executives found that:

• 53% of respondents cited difficulties in collecting patient data required for value-based care reporting.

• 48% identified administrative burden as a major barrier.

• Many expressed concern about the lack of actionable insights derived from existing reporting systems.
  

The healthcare industry’s move to value-based care demands new tools, processes, and mindsets to overcome these hurdles.

Why Patient-Reported Outcomes (PROMs) Are Critical

Patient-Reported Outcomes Measurements (PROMs) are defined by the FDA as “any report of the status of a patient’s health condition that comes directly from the patient.” These metrics include measures of symptoms, physical functioning, mental health, and quality of life, offering a direct lens into patient experiences and outcomes.

In value-based care models, PROMs serve as critical components for tracking success. They provide the granular, patient-centered data that aligns perfectly with quality measures required under frameworks like MIPS. According to a 2023 Health Affairs study, providers that incorporated PROMs into care delivery saw a 22% reduction in readmissions and a 15% increase in patient satisfaction scores.

Industry-Wide Benefits of PROMs in Value-Based Care

1. Meeting Regulatory Requirements with Precision

MIPS demands reporting on measures such as patient satisfaction and functional improvement, which traditional data systems often overlook. PROMs fill this gap. OutcomeMD’s PROMs platform offers automated tools that simplify compliance by capturing real-time patient-reported data aligned with MIPS criteria.

Providers using PROMs have shown greater success in achieving top-tier MIPS scores, leading to enhanced reimbursement and reduced penalties. For example, a study published in the Journal of Orthopaedic Surgery revealed that practices leveraging PROM tools achieved MIPS bonuses 30% higher than those relying solely on traditional reporting.

2. Improving Patient Engagement and Outcomes

Value-based care’s ultimate goal is not just compliance but better care delivery. By integrating PROMs, providers empower patients to actively participate in their care. Research from the New England Journal of Medicine shows that patients who complete PRO surveys are twice as likely to adhere to their care plans and experience better health outcomes.

An oncology group that adopted PROMs to monitor patient pain during treatment reported a 38% reduction in emergency department visits, highlighting how real-time patient feedback can drive proactive care interventions.

3. Reducing Administrative Burden Through Technology

One of the greatest challenges of VBC compliance is the administrative workload. A McKinsey report estimates that clinicians spend up to 50% of their time on documentation. OutcomeMD’s platform addresses this by automating much of the data collection, aggregation, and reporting processes. This reduces the burden on providers and frees up valuable time for patient care.

4. Benchmarking and Continuous Improvement

PROM data doesn’t just help providers comply with regulations; it offers rich insights for benchmarking and quality improvement. For example, orthopedic practices using OutcomeMD’s platform have been able to compare their outcomes with national averages, enabling them to identify performance gaps and implement evidence-based interventions. This capability not only supports compliance but also drives long-term improvements in care quality.

PROMs and the Future of Value-Based Care

As the adoption of value-based care accelerates, the demand for PROMs is expected to grow exponentially. A 2023 HIMSS report projects that the global market for patient-reported outcome tools will reach $3.1 billion by 2027, driven by regulatory mandates and the rising focus on patient-centered care.

Providers that invest in PROM solutions today are positioning themselves for success in this rapidly evolving landscape. OutcomeMD’s platform, for instance, is designed to seamlessly integrate into existing workflows, making it easier than ever for providers to meet regulatory requirements while improving patient outcomes.

Conclusion: PROMs as the Foundation of Value-Based Care Success

Compliance with value-based care models like MACRA and MIPS doesn’t have to be a burden—it can be an opportunity. By leveraging PROMs, providers gain actionable insights, reduce administrative complexity, and deliver better care. These benefits go beyond compliance, enabling organizations to thrive in the value-based era.

As healthcare continues to evolve, one thing remains clear: patient-reported outcomes are not just a regulatory necessity—they are the key to delivering meaningful, patient-centered care. Providers who embrace this shift will not only achieve compliance but will also set a new standard for healthcare excellence.

Jessica Rains is the Director of Customer Success & Marketing at OutcomeMD, where she helps healthcare providers achieve measurable success through patient-centered outcome tracking.