The Centers for Medicare & Medicaid Services, the nation’s largest payer, has set a clear direction with its publication of targets: By 2018, 50% of fee-for-service payments will be through alternative payment models, such as ACOs and bundled payments, and 90% of FFS payments will be tied to quality or value. And CMS has begun to introduce mandatory bundles. This suggests that all providers will
need to develop population health competencies, including the ability to manage risk for both cost and quality.
This report outlines the top challenges providers are facing in the transition to value-based care. The results this year reinforce both the magnitude of the task and leaders’ reluctance to make a full commitment while details of emerging but still largely unknown payment models are unresolved.
Nearly six years after passage of the Patient Protection and Affordable Care Act, the healthcare industry is in the midst of a massive retooling that is dramatically altering the way we think about cost management, strategic partnerships, and customer service.
Fee-for-service reimbursement is giving way to new models of care delivery and payment to support a system based on pay-for-value. With financial risk or payments tied to value measures (such as patient satisfaction, clinical performance, and population health), compensation and reimbursement will increasingly be tied to value-based incentives.
Today in healthcare the communication infrastructure is the backbone in IT. New reimbursement models are amplifying the need for care coordination, and communication between multiple departments, constituencies, and workflows is required. High-performing healthcare systems are adopting enterprise communication solutions to eliminate silos of information, improve patient care during critical situations, and make the most of their IT budget.
Creating a state-of-the-art clinical documentation improvement (CDI) program isn’t just about boosting coding accuracy. It’s a key strategy in managing the transition from volume-based to value-based care, say healthcare leaders. That transition is a risky endeavor that is putting hospital and physician financial performance to the test. As hospitals participate in new care and business models aimed at improving value, leaders must ensure that their organizations are able to maintain reimbursement levels, effectively treat the chronically ill—especially in outpatient settings—and gather accurate data that will allow them to assess performance and segment their varying populations. While some organizations often believe they are leaving revenue on the table because of documentation and coding issues, CDI offers numerous opportunities for improving financial performance, finds a recent HealthLeaders Media survey of 149 healthcare executives at provider organizations.
Providers are increasingly making the leap and investing in their organizations in preparation for value-based care. However, while no one wants to be behind the competency curve when it arrives, it can be expensive to build competency for a new model before it is financially viable, causing providers to remain cautious.
In many aspects of healthcare, we see indications of change, with movement toward new payment models and investments in infrastructure to support the delivery of value-based care. Cost control remains a top financial lever, but the discipline is becoming more complex. From a brute-force perspective, controlling cost has a direct effect on operating margin, which provides the classic move of cost control through cost cutting. Now, though, organizations need new command over cost factors themselves.
The shift to healthcare’s value-based model is being accelerated by measurable goals and an aggressive timeline. With improved patient experience as the objective, addressing root causes that impact patient satisfaction scores is crucial to success.
How can providers and insurers reduce costs and increase patient satisfaction? In the evolving value-based care (VBC) model, better healthcare IT is a must have. L.E.K.'s Joseph Johnson and Harsha Madannavar identify key success strategies in our latest Executive Insights.
CEP America provides three case studies illustrating how integration across the acute care continuum and innovative models of care help manage populations by improving throughput, reducing readmissions, and producing superior hospital-wide metrics.
Published By: Parallon
Published Date: Oct 12, 2015
To succeed in today’s healthcare environment, hospitals and health systems must evaluate the best operating model for key functions to enhance efficiency and optimize performance. This often involves determining whether partnering with another organization to perform a business function makes sense for you.
In the rough-and-tumble world of community and rural hospitals, the phrase “innovate or get left behind” is no longer a scary suggestion thrown out by expensive consultants, but a daily reality for CEOs. Rocked by reform and big changes in areas including financing, care models, and population trends, chief executives are getting used to making bold leadership decisions on a regular basis.
In a panel discussion at the 12th annual SAS Health Analytics
Executive Forum in May 2015, leaders from Dignity Health,
Horizon Blue Cross Blue Shield of New Jersey, Janssen
Pharmaceuticals and SAS shared what they have done to prove
the value of analytics to their business leaders – and what has
worked for them as they developed an analytic culture in their
organizations and put analytic insights to work.
This paper is divided into two parts. The first part provides some background and a comparison of the types of episode analytics. Part two explores the real-world experiences of payers and providers in using episode analytics for payment bundling and other purposes.
Finally, we offer some recommendations on how to use episode analytics to reduce variations and manage contracts that involve financial risk.
Published By: Allscripts
Published Date: Oct 22, 2014
Download this case study to learn how Hutchinson Clinic, an independent, multi-specialty practice, was able to reduce costs, manage their patient population, and have 100% of their providers successfully attest for Meaningful Use Stage 1 with Allscripts TouchWorks® EHR solution
This paper, the second in a series addressing four key challenges of healthcare reform, focuses on actions you can take now to streamline core administrative processes to drive efficiency and reduce costs.
Published By: Evariant
Published Date: Nov 14, 2016
Changing healthcare market forces, such as value-based care models, consolidation, and payer mix erosion, have propagated declining margins and fueled hyper-competition among healthcare organizations vying for market share. In this new world, determining effective patient engagement strategies has become paramount for hospitals and health systems as they strive to acquire, retain, and re-activate patients, and, ultimately, drive revenue. Now, more than ever, it is critical that healthcare organizations create and maintain positive, lasting relationships with their patients, both current and prospective, working to attract them into their network and keep them there.
Published By: Allscripts
Published Date: Oct 14, 2015
Independent physician practices are weighing their options as fee-for-service reimbursement models shift to value-based-care models, such as Accountable Care Organizations (ACOs). Download this white paper to learn more about forming ACOs.
It’s clear: the healthcare industry is in need of change. And today, the system is undergoing a critical transformation as it shifts from a volume-based to a value-based delivery model. Gone are the days of simply treating illness. Now, the focus is on managing the episode of care, containing the costs of delivery, optimizing services and improving patient outcomes.
Modern solutions like CA PPM continue to raise the bar above last-generation IT demand management tools, continuously providing new features to ease the burden of the PMO, the financial manager, the resource manager and the product manager.
In the last few years, new vendors looking to exploit the large and increasingly influential project and portfolio management (PPM) market have developed modules that “snap” into their SaaS platforms. These vendors claim their tools are easy to install, easy to manage and save customers money. It sounds too good to be true. And for most organizations, it is.
Carefully consider whether you need a PPM solution that is only capable of providing low-level functionality for the project manager, or if your organization could benefit from PPM technology that provides 360-degree optics across your organization, delivers actionable business intelligence and enables extensive modeling and forecasting capabilities to make data-driven business decisions.
Published By: Cognizant
Published Date: Oct 23, 2018
Value-based care is the predominant model for enabling the healthcare industry to control costs and deliver better information to consumers. The basic idea is that reimbursements are based on the quality of the outcome of a procedure, episode of care, use of a device or therapy. Under this model, life sciences companies are rewarded for improving health outcomes and/or reducing the costs to achieve those outcomes. It requires life sciences companies to rethink many of their processes, from R&D through the commercial phase. Navigating those momentous shifts requires that life sciences companies embrace a range of digital technologies which will enable a holistic approach to value-based care. This white paper will examine the drive for value-based care, its impact on life sciences companies and how technology platforms can address the challenges the industry is facing.
Published By: Infomatica
Published Date: Mar 05, 2014
It’s no secret—healthcare is transforming. The transition to value-based care is well underway; healthcare players are feeling the impact and each has a role to play, including you! Moving to a value-driven model demands agility from every person, process and technology. These changes are generating more data than ever, there is a lot of data, in fact IDC Global Health Insights predicted that over the next 10 years, the amount of digital healthcare data created annually will grow 44 fold. Organizations that lead the pack and succeed will be those where clinicians, business leaders and patients are empowered with access to clean, safe and connected data. Learn more about your role in putting information to work…