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

Value-Based Care News

Risk-Value-Based Payment Programs a Return on Investment?

By Jacqueline DiChiara

- Value-based payment readiness is apparently an area of weakness for senior financial executives, reports an executive survey from the Healthcare Financial Management Association (HFMA) and Humana.

value-based payment program

An analysis of return on investment (ROI), readiness efforts, and projected progress among 146 chief financial officers, financial vice presidents, finance directors, and the like confirms notable variation in collective views across the healthcare industry about value-based care readiness.

According to HFMA, 60 percent of senior financial executives state their organizations will potentially possess needed capabilities within a 3-year time frame to achieve risk-based value success with regard to interoperability, business intelligence, real-time data access, and the advancement of chronic care management.

Seventy percent of the surveyed executives project their organizations require more advanced interoperability capabilities within the next several years, says HFMA.

Although over half of executives confirm their organizations achieved positive ROI from value-based payment programs, over a quarter report they are experiencing adverse ROI effects.

Making the value-based payment/ROI connection

The abandonment of fee-for-service and the embrace of connecting reimbursement to quality and outcomes may indeed prove valuable when it comes to dollars in and dollars out.

Value-based payment programs – including accountable care organizations (ACOs) and pay-for-performance realms – are a means of enhancing cash flow. Value-based payment programs reportedly saved the Blue Cross Blue Shield Association (BCBSA) $500 million in 2012.

Resultantly, there were reported reductions in visits to the emergency room (by 12 percent), hospital admissions (by 23 percent), and the cost of care for diabetic patients (by 9 percent), all allegedly linked to the value-based payment movement.

As reported, 42 percent of hospitals confirm at least 10 percent of their revenue relates to value-based contracts. The reason for such? It is possible, according to a Kaufman, Hall & Associates study, that the healthcare industry’s collective perspective about value-based payments is transitioning to become more wholeheartedly embracing.

The active assimilation of value-based reimbursement and integration is essential, as reported. According to Bruce D. Broussard, Humana’s CEO and President, Humana reaped benefits from maintaining relationships with healthcare providers who are reimbursed in connection with cost and quality. Says Broussard, Humana saw a 25 percent improvement in Healthcare Effectiveness Data and Information Set (HEDIS) scores, which evaluate levels of care and service performance.

Smoothing out the value-based risk-based wrinkles requires strategy

What strategies exist to best embrace the value-based movement when it comes to promoting and advancing revenue cycle and greater financial stability for healthcare providers?

One point to consider is the possibility of a seamless relationship between physician engagement and effectively executed value-based care models. Strategically applying risk involves maximizing physician engagement initiatives, as reported via an Advisory Board survey.

Indeed, promoting awareness that financial risk is indeed shared means actively engaging other providers to promote future financial winnings within the realm of ACOs and projected value-based plans.

As reported, preparation on behalf of finance departments is key to value-based success. Of crucial concern is addressing the specific needs of various new delivery models, such as accountable care organizations (ACOs) and other alternative payment methods, and measuring a slew of risk-related variables through active data initiatives to keep costs under control.

Considering the announcement earlier this year from the Department of Health and Human Services (HHS) to reward value regardless of the quality of care delivered, considering what’s next on the horizon and staying safely in the black may mean the incorporation of the above strategies as the value-based movement gains headway.



Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...