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

Value-Based Care News

ACOs Fighting Revenue Cycle Setbacks, Says Black Book Survey

By Jacqueline DiChiara

- The fastidious partnership of financial incentive and risk is a delicate balancing act the healthcare industry is now increasingly pressured to perfect. As the healthcare system expediently swings away from fee-for-service and into the realm of value-based care, healthcare reform regulation continues to evolve. Resultantly, accountable care organizations (ACOs) are finding themselves caught in the middle of an often elusive value-based web.

black book survey

Healthcare expenditures may top $3 trillion within the next 5 years, confirms yesterday’s press release from Black Book, in tandem with RevCycleIntelligence.com's earlier coverage on Black Book's findings regarding shrinking reimbursement data. As the pendulum continues to swing onwards, ACOs are reprioritizing their primary financial objectives. According to Black Book, 95 percent of 200 ACO-based health plan executives cite financial tools as a central priority. Conversely, 19 percent of working ACOs confirm the satisfactory installation of financial technology, outsourced services, and consulting will foster long term ACO-based success.

“Despite the growth in ACO contracts with payers, few ACO participants have access to reliable claims data and trouble taking consistent clinical quality data from electronic health systems due to interoperability challenges,” states Doug Brown, President of Black Book Market Research LLC. “The majority (64%) of the healthcare provider industry responding to this survey is not moving with haste toward the objective of building a reimbursement model that features value-based payments,” he adds.

59 percent – a decrease of 78 percent compared to last year’s data – of CFOs confirm they are indeed torn between those revenue management services fast-tracking cash influxes to maintain current levels of fee-for-service reimbursement and choosing successful ACO strategic solutions to stimulate future imminent risk-bearing payment models, says Black Book’s release.

“Large ACO’s have the capital and provider base to strategically select vendors who can deliver end-to-end financial services and software now, ahead of tackling population health, clinical integration and business intelligence tools into the technology amalgam,” Brown confirms.

Value-based payment contracts are very new, says Brown. Resultantly, healthcare providers lack refined IT capabilities and are grappling to project upcoming costs. “Despite 40 percent of large hospital and physician organizations using big data population health solutions, only 14 percent have acquired ACO-dedicated risk management, analysis and provider payment incentive tools,” explains Brown.

Over three-quarters of newly-forming ACOs confirm they are merely working with capital that is too restrictive to effectively and expediently stimulate both financial operations and technology in regard to value-based eligibility within the remainder of the year.

“85 percent of all hospital CFOs and 81 percent of ACO executives agree that without a strong financial solutions vendor to provide value-based reimbursement software, outsourced services and support, and consulting, they will be forced to opt out of many key risk-based contract opportunities through 2016,” confirms the Black Book press release. “Twelve percent of health care payments are currently made through value-based programs which Black Book estimates to surge over 50 percent by year-end 2019,” the release confirms. 

Brown maintains that healthcare providers are facing a new wave of increased pressure to assume greater levels of financial risk for managing the care delivered to their covered populations. The majority of hospitals and physician groups, he says, simply lack the latest staff or technology competencies to remain independently viable.

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