How can healthcare organizations best approach the need to manage population health, develop value-based contracting strategies, and assume risk in an environment of reform? During HFMA’s sixth annual Thought Leadership Retreat this past October, providers and industry experts shared these strategies and more.

Invest in data infrastructure that supports the exchange of data as well analytics capabilities that can pinpoint opportunities to improve value. Across the industry, there is high competition for competent data analysts and a need for surveillance tools that can track and monitor data and alert providers to the need for interventions. Providers should consider developing a governance model for business intelligence, so leaders and staff will have access to timely clinical data and will be better able to act on the data.

Look for opportunities to achieve economies of scale through partnerships or linkages with other systems—including competing systems. Achieving economies of scale will be critical to a provider’s ability to reduce costs and gain access to capital in an era of reform. “It’s hard work to develop collaborative relationships with payers and employers, but it’s necessary work,” says Carol A. Friesen, FHFMA, president and CEO, Crete Area Medical Center. “Maybe it’s self-serving to ask payers and employers for their assistance in reaching patients with chronic disease so that we can improve care management for these patients, but collaborative relationships such as this are going to help us get the outcomes we need as a country.”

Seek ways to enhance efficiency of care and ensure that the right care is being provided in the right setting. Thought leaders in health care agree that a change in emphasis from hospital care to primary care will be critical in the transition to value-based business models in health care. “That’s where most care originates—with primary care physicians,” says Jeffrey Weinstein, executive director, Hunterdon Healthcare, Flemington, N.J.

Experiment with payment models and care delivery approaches. Across the country, health plans are pushing providers to take on a greater share of risk. To get started, providers should consider focusing on ways to improve care management and reduce costs for Medicare Advantage patients; driving down per-capita cost; eliminating unnecessary fixed costs throughout the delivery system; and working on ways to enhance quality scores and the patient experience. They should engage patients, physicians, and purchasers in the organization’s efforts and apply what is learned across the continuum of care.

Develop new ways to actively engage patients in their care. At Sharp HealthCare, based in San Diego, patients receiving care in the health system’s accountable care organization may call a nurse who can assess and evaluate health symptoms, make recommendations for care, and contact physicians on a patient’s behalf. Advocate Health Care, based in Oak Brook, Ill., has hired care management coordinators to work with high-risk patients in physician offices. 

Read the full report.


Jeni Williams is managing editor, content development, HFMA’s Westchester, Ill., office.

Publication Date: Wednesday, May 01, 2013

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