Reimbursement News

Top 4 Strategies to Achieve Affordable Value-Based Care

In order to stay above water, healthcare providers must develop tactics to adequately manage risk, maintain strong ROI levels, and assess weaknesses.

By Jacqueline DiChiara

- Value over volume is the name of the revenue cycle game, with the reimbursement concept of “less is more” taking precedence. With the transition to value-based care underway, here are some top collected strategies for healthcare providers to consider.

value-based care reimbursement

Acknowledge you are merely playing a game of ‘Risk’

In order to stay above water, healthcare providers must develop tactics to adequately manage short-term risk.

“If policymakers want to successfully transform the current volume-based payment system to one based on value, they need to understand these impediments to risk-taking and offer the tools providers need to make this transition successful,” said Chester A. Speed, JD, LLLM, and Nikita Stempniewicz of the American Medical Group Association.

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  • “If these issues are overlooked, the opportunity to reform the system for both the benefit of patients and programmatic efficiency may be lost.”

    Focus on matters of physician engagement, not just money

    C-suite executives are honing in on the importance of engaging physicians to keep costs down and quality high, according to a survey of 157 CEOs from the Advisory Board Company.

    “[Physician] engagement is imperative to an organization’s successful transition to value-based care models,” stated Chas Roades, the Advisory Board’s Chief Research Officer.

    “Driving fundamental and sustainable changes to providers’ business model is impossible without buy-in from the clinicians on the frontlines of patient care.”

    Researchers recommended healthcare providers adapt the following 4 strategies to maintain high performance levels: reformat service portfolios for population health, reinforce primary care physician alignment, develop direct-to-employer contracting, and regulate avoidable utilization.

    By directly associating a physician’s compensation level with care quality, care coordination and overall conditions are reportedly heightened.

    “Non-productivity incentives play a key role in the current compensation arena and will continue to gain importance in future years,” stated Justin Chamblee, Senior Manager at the Coker Group. “But you cannot incentivize physicians based on outcomes when all your reimbursement is on fee for service.”

    Do not be afraid to really look at your numbers

    Following an announcement from the Centers of Medicare & Medicaid Services (CMS) about a goal to associate 90 percent of reimbursements to value-based or quality-based care by 2018, healthcare providers are becoming more focused on maintaining a healthy revenue cycle.

    “Medicare, Medicaid, and commercial health plans are all pushing toward paying hospitals and physicians for value, effectively pushing financial risk upon the providers,” asserted Joe Kuehn, Advisory Partner at KPMG’s Healthcare & Life Sciences Practice.

    “Finance departments will need to prepare to manage these challenges and have better systems to measure performance against established targets including the cost and quality of care for example, so they can manage in this new environment.”

    “Data & analytic tools are an important component for improving the finance function’s effectiveness, especially since there are so many variables that need to be addressed in the delivery of care,” said Mark Jamilkowski, Managing Director.

    “The tools available now can take that unstructured information from patient records, billing, and sources outside the provider organization that can help provide meaningful context around measuring healthcare quality and overall costs."

    Strengthen value-based readiness weaknesses

    According to an executive survey from the Healthcare Financial Management Association (HFMA) and Humana, 60 percent of senior financial executives confirm their organization will be ready within the next 3 years to handle risk-based value aftermath.

    Executives say they are focused on interoperability, business intelligence, real-time data access, and chronic care management.

    At least half of the 146 CEOs and executives surveyed confirm the incorporation of value-based payment programs yielded positive returns on investment (ROI).

    Regarding another hospital survey from Kaufman, Hall & Associates, over 40 percent of hospitals verify at least 10 percent of their revenue stems from value-based contracts.