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Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
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As pundits rattle off statistics about how little value Americans get for our healthcare spending, the public demand to lower the overall cost has grown. Providers (physicians and hospitals) are being asked to deliver more (or better) care for less; offering value increasingly means engaging in risk-based reimbursement arrangements. Although there are historical examples of risk-based reimbursement (DRGs in the 1980s, capitation in the 1990s), the Affordable Care Act of 2010 has brought a laser focus on risk-based reimbursement, and current examples are everywhere:
Providers are asking themselves, “What are we doing to respond to a growing emphasis on risk?” More important, however, they should be asking, “Are we well equipped to take on risk?” Provider organizations are often ill-prepared for risk. Participation requires an organizational commitment to building skills and not just continuing business as usual.
How can organizations get better at taking on risk, and how does an organization know when it is ready?
Improving your ability to accept risk-based arrangements requires a high level of commitment and cultural transformation. Many providers find success by starting with low-risk arrangements, such as performance incentives or a service bundle. The greatest challenge is shifting the mind-set of both clinical and nonclinical personnel to find the means of providing value, not simply through the reduction of costs but also through an improvement in outcomes for patients.
There are many places where the value chain can be broken because the patient experience involves numerous touch points and care transitions. To thrive in a risk-based model, an organization must establish a mentality that achieving the desired value-focused outcome is the primary goal. Providers will be well positioned to accept risk when they possess the following attributes:
If your organization is pursuing risk arrangements, it should be working to build these skills. In the current marketplace, providers will undoubtedly be asked to demonstrate value by taking on more risk-based reimbursement. Before recommending a risk-based arrangement to your CEO, carefully consider the gaps in your organization so you’ll be prepared for the pitfalls.
Jason Lee is a senior manager, ECG Management Consultants, Inc., Walnut Creek, Calif.
Publication Date: Friday, July 19, 2013
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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