An HFMA survey of healthcare finance leaders found varying approaches to care coordination payment mechanisms, infrastructures and strategies for generating an ROI.
- A large majority of healthcare finance leaders expect to increase their investments in care coordination over the next two years, an HFMA survey found.
- Some respondents said they receive funding from health plan partners or Medicare, but payment mechanisms for care coordination remain works in progress.
- Survey respondents see the biggest ROI from care coordination in managing high-risk patients and in activities such as guiding care transitions.
As population health management becomes more of a focal point in healthcare, providers are ramping up their care coordination programs to ensure patients don’t fall through the cracks.
That trend was apparent in a recent HFMA survey, with 70% of respondents saying their care coordination budget will climb during the next two years.
“With increasing efforts to reduce the total cost of care for patient populations, care coordination has become an effective strategy for health systems to more efficiently deliver care,” said Katie Gilfillan, HFMA’s director of healthcare finance policy, physician and clinical practice. “Better care coordination ensures patients have access to care in the appropriate settings and optimizes their care paths.”
Where the increased spending is likely to go
Staffing will be the primary area of investment for care coordination budgets, according to the survey, which was conducted in Spring 2019 and included responses from 81 healthcare finance executives. Almost half of respondents’ care coordination budgets is allocated to staffing, with the remainder evenly split among technology, analytics, social support resources and behavioral health integration.
“We make a significant investment each year in salary and benefits,” said Donna Littlepage, senior vice president for accountable care strategies with Carilion Clinic in Roanoke, Virginia. “It’s an investment we feel we need to make to take better care of our patients.”
“All too often, people buy a solution and say, ‘Hey, this is a new solution, and it will do X, Y and Z,’” said John Zabrowski, senior vice president and CFO with Virginia Hospital Center in Arlington, Virginia. “But if somebody isn’t doing the blocking and tackling and making sure the workflow is as effective as it can be, the benefit of technology can’t be leveraged as much.”
Technology moves to the forefront when an organization is ready to scale a care coordination program, Zabrowski added.
Risk stratification tools and processes constitute the most important investment in care coordination, said Bruce Henley, vice president and CFO with St. Elizabeth Physicians, the multispecialty physician organization of St. Elizabeth Healthcare in the Greater Cincinnati area.
“Technology is a must, but it’s also the people,” Henley said. “The technology is great at identifying the high-risk patients, but then you have to be able to operationalize that information. Communicating and coordinating with your providers in your practices is crucial because the technology won't catch every high-risk patient.
“Once you identify that high-risk or rising-risk population, the people whom you have to monitor, then you can start to develop the personnel and processes that you need to develop a successful care management program.”
Finding ways to pay for care coordination
Funding mechanisms for care coordination vary, with 24 of 60 respondents (40%) to one question saying they build a per member per month fee or other specific care coordination fee into their payment model. Others use shared shavings, while 14 of 60 (23%) said they don’t have a specific funding source.