Cover Story
A Blueprint for Building a ‘Risk Ready’ Healthcare Organization
The cornerstone capabilities healthcare providers require for success under risk contracts are contract modeling and negotiation, care management and coordination, analytics and technology, and relationships and alignment.
By Daniel J. Marino
Web Exclusives
Where Providers Are Finding Value-Based Profit
Healthcare provider organizations that are seeking ways to successfully accomplish the shift from fee-for-service to value-based payment can gain insight from the experiences of provider organizations that are industry leaders in this transition.
By Rich Daly
AI Meets Health Care’s Turnover Problem
One health system found that artificial intelligence (AI) can provide an effective means to ensure the right nurses are hired for the right roles, which helps it meet strategic goals on quality, satisfaction, and costs.
By Florence S. Chang and Myra Norton
Transitioning to a New Medicare-Based Benchmarking Paradigm for Commercial Payment
As commercial health plans adopt a case-rate approach to payment based on Medicare’s MS-DRGs, modifications are needed to account for how health plans’ populations differ from the Medicare population.
By Glen Kazahaya
On Point
The Conscience of the Generic Drug Market
Created to address the high costs and shortages of generic medications, the not-for-profit generic drug manufacturer Civica Rx aims to be a societal asset by providing patients across the nation with affordable access to the medications they need.
By Jenna Jackson and Sierra Smith, MBA
Features
7 Considerations in the Financial Modeling of Value-Based Payment Arrangements
In preparing for the impact of changing to value-based payment, hospitals must be able to predict the gain or loss from related incentives, penalties, volume changes, and other factors. Seven considerations provide a guide to successfully managing the shift.
By Jim Ryan, MBA, and Charles Brown, MBA
Commentary
Preparing for BPCI-A: Avoiding the Common Mistakes Providers Make when Implementing New Payment Models
The primary goal for healthcare providers participating in Bundled Payments for Care Improvement Advanced (BPCI-A) should be to master the competencies associated with becoming a high-value provider.
By Deirdre Baggot, PhD, MBA, RN
Lessons Learned from New York State’s Transition to Value
New York is a leader among U.S. states in promoting the healthcare industry’s transition to value-based payment, and healthcare providers nationwide can benefit from understanding the details of the state’s approach.
By Michael Keyes, MBA
Case Study
Getting Proactive About Bundles
Building on lessons learned from early bundle experiences, a midwestern health system is proactively designing its own bundles as it works with insurers and the state to craft bundles that better represent clinical and operational realities.
By Anne Stockton, Elizabeth Lipinski, Adam Kowalski, and Susan White, PhD
Special Feature
Creating a Consumer-Centric Healthcare Delivery System: A Report from HFMA’s 2018 Annual Conference
A cohort at HFMA’s Annual Conference examined various strategies for enhancing the patient financial experience.
Click here to download the full report
Focus Area
Accounting
Beyond the Rhetoric: Implications and Unintended Consequences of Tax Reform and Medicare Policy
Tax reform and changes in federal healthcare policy could have the unintended effect of exacerbating the challenges U.S. hospital face in contending with uncompensated care.
By Chris Bell, CPA, MS, and Paul Holden, FHFMA
Columns
From the Chair
The Ongoing Pursuit of Better Payment Models
The healthcare Financial Management Association (HFMA) will be source for all things related to payment trends, as it may be one of the hottest topics in our industry.
By Kevin Brennan, FHFMA, CPA
Eye on Washington
The Trump Administration’s Proposed Reorganization of the Federal Government: Implications for Health Care
Following up on what is perceived as a compelling mandate for reform, the president is proposing significant reforms to government structure that may improve administrative efficiency but may at the same time gut what is left of the nation’s safety net.
By Ken Perez
Integration
Understanding the System Bottom Lines for Market-Based Primary Care
The concept of primary care is being transformed by changes to its subsystems related to demand, supply, organization, and linkages.
By Keith D. Moore, MCP, and Dean C. Coddington
From the President
It’s All Connected
Efforts to improve the patient financial experience should not be undertaken in isolation. HFMA President and CEO Joe Fifer explains why.
By Joseph J. Fifer, FHFMA, CPA
Supplements
HFMA Research Report
Data Analytics and the Revenue Cycle
A research highlight that delves into key takeaways from a May 2018 HFMA member survey about the use of data analytics in the revenue cycle.
Sponsored by MedeAnalytics
HFMA Action Brief
Strategies for Automating Accounts Payable
Tips-focused article about automating procurement and payables processes that shares benefits and offers real-world success strategies.
Sponsored by GHX
Advertising
Trendsetter
Premier: At the Tipping Point for Assuming More Risk
An in-depth look at how organizations can build capabilities to implement effective value-based payment contracts and care delivery models.
