Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

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How to Mitigate Risk With a Value-Based Strategy

With healthcare solutions adopting a more value-based approach, mitigating risk is key to experiencing the best reward.

- Value-based payment options have become the trendy buzzword in the healthcare sector. The rise of the Affordable Care Act has increased the importance of practices that focus on quality of care over quantity. Keeping patients healthy and out of the hospital is more important than running a barrage of tests and charging for each one.

However, as with any new solution, especially one that changes a long standing practice like fee-for-service, there are going to be challenges and risk associated with it. The ability to mitigate this risk and overcome the challenges is what dictates success and failure.

In a recent guest column for HFMA, Sasha Preble, a former vice president of Accountable Care Solutions and current vice president of Advisory Services for Aetna, discussed mitigating risk when it comes to value-based payments in the healthcare landscape. She laid out four main steps:

•Determine the types of risk inherent in new payment models and how they can best manage them.

•Fill capability gaps and add resources to help manage risk.

•Use a wide range of strategies to mitigate risk across the organization.

•Carefully craft the provider incentive structure.

“Although assuming more risk gives providers unique potential for revenue growth, it also presents a host of variables and uncertainties,” Preble wrote. “Taking on greater financial responsibility gives providers a greater incentive to deliver care in the most efficient, cost-effective manner possible. In many cases, risk can act as the driving force that pushes an organization toward the transformation needed to achieve the Triple Aim.”

Risk is something that should not be taken lightly but is also not something to fear. It is the basic risk versus reward scenario. While companies will need to risk when it comes to performance, quality, utilization, actuarial and pricing, the reward of new revenue streams and greater success is too much to overlook.

Each form of risk does present a difference mitigation strategy. However, many of these basics are the same. The first step is to identify and address any capability gaps that exist within their organization. Then, tools are used to leverage technology, processes and workflows to better manage and monetize risk. This happens in four areas: raw data, information, knowledge and insight and application.

“As healthcare reform continues to radically transform care delivery and payment models, provider organizations face new opportunities and new risks,” Preble wrote. “To mitigate the risks, hospitals and health systems must leverage new types of data, information, analysis, knowledge, and action on a broader scale than they have ever managed in the past. With the right tools and strategies, providers can position themselves for financial success and make strides toward achieving the Triple Aim of better care, improved health, and reduced costs.”

 

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