Build­ing an Of­fen­sive Game Plan to Nav­i­gate Pay­ment Re­form


As Amer­ica’s health­care pay­ment sys­tem is in a pe­riod of rapid evo­lu­tion, savvy lead­ers are not wait­ing to find out what hap­pens with U.S. health­care re­form. They are build­ing the team, writ­ing the play­book and cre­at­ing the cul­ture that will al­low their or­ga­ni­za­tions to win, re­gard­less of which pay­ment sys­tems and de­liv­ery mod­els gain trac­tion. Richard P. Miller, CEO at Vir­tua, a multi-hospi­tal sys­tem based in Marl­ton, N.J., is rapidly repo­si­tion­ing his or­ga­ni­za­tion to suc­ceed in an un­cer­tain en­vi­ron­ment. He said: “Frankly, I don’t think we’re in a wait-and-see mode any­more. We are in a prepa­ra­tion for change mode.” Ex­e­cut­ing that change presents a sig­nif­i­cant chal­lenge for all health­care sys­tems. Re­search con­ducted by GE Health­care shows that the tran­si­tion to more value-based pay­ment mod­els, sys­tems with more ac­count­able care, re­quire three dis­tinct phases: Plan­ning, Im­ple­men­ta­tion and Op­er­a­tional. Be­fore a health sys­tem can ef­fec­tively be­gin a tran­si­tion to ac­count­able care de­liv­ery, its lead­ers must un­der­stand the spe­cific tasks and ca­pa­bil­i­ties nec­es­sary in the plan­ning, im­ple­men­ta­tion and op­er­a­tional phases. That al­lows them to iden­tify the gaps be­tween its cur­rent ca­pa­bil­i­ties and those that will be needed for a suc­cess­ful tran­si­tion. The re­search found that five broad cat­e­gories of tasks are foun­da­tional to any new pay­ment mod­els: 1) Im­ple­ment the strat­egy 2) Cre­ate a health­care cul­ture with ac­count­abil­ity 3) Stan­dard­ize the de­liv­ery of care 4) En­able in­for­ma­tion to aid in decision-mak­ing 5) Co­or­di­nate care de­liv­ery “If you start to think about these five core job func­tions, we are con­fi­dent you are go­ing to add value for your in­sti­tu­tion, re­gard­less of where pay­ment re­form is go­ing,” said Mark Dente, MD, Chief Med­i­cal In­for­mat­ics Of­fi­cer, GE Health­care. Un­der­stand­ing the spe­cific tasks that must oc­cur in those phases is an im­por­tant step in pre­par­ing for pay­ment re­form. “There will be those that will prob­a­bly be ex­tremely suc­cess­ful in the brave new world. And then there will be those that will strug­gle with it,” Dr. Dente said. “And the ques­tion is: What do you need to do to po­si­tion your­selves to be on the win­ning side?”

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