FINDING BALANCE IN THE NEW NORMAL: BRIDGING THE GAP BETWEEN TRADITIONAL AND VALUE-BASED CARE STRATEGIES
The regulatory environment for providers is tremendously uncertain and rapidly changing.
If providers want to thrive in this new world of valuebased care, they need to better understand how clinical and financial data intersect.
Anita Mahon, chief strategy officer for the Value-Based Care Business of IBM Watson Health, and David Jackson, vice president of professional services for Truven Health Analytics, a part of IBM Watson Health, offered data-driven strategies for success during a webinar on June 15. The entire webinar can be accessed at ModernHealthcare.com/ Finding Balance.
Approach your business challenges with a four-step plan
Whether devising a new approach for fee-for-service payments or implementing new programs for valuebased care, it’s important to conduct a data-rich readiness assessment that identifies your organization’s risks and opportunities. Use those insights to create an action plan that prioritizes tasks based upon impact and ease of implementation, and make sure to establish a governance structure to implement that plan. Don’t forget to think about how your approach will affect your post-acute network, and make sure to create a strategy for engaging physicians and staff. Finally, it’s crucial that you use objective data to continually monitor the program’s progress, and benchmark your hospital against peer institutions.
A balanced scorecard can help predict the future
This tool can help offer insight into future opportunities by tracking performance in clinical metrics like length of stay and mortality, as well as financial metrics like Medicare spending per beneficiary (MSPB). This can help you benchmark against your competitors and decide where to invest resources. Doing this at the service-line level can help determine whether certain service lines are driving exceptional results and could be identified as centers of excellence.
Pending legislation would change the healthcare landscape
The healthcare bill passed by the House and the bill under consideration in the Senate would make significant changes to the U.S. healthcare environment by rolling back Medicaid, changing the way pre-existing conditions are covered and making significant changes to taxes and individual plan subsidies. There will be a massive increase in the nation’s uninsured population, even though the expected magnitude of that change is disputed. Providers need to look at their payer mix, state and local laws and other financial data to understand how the bill
will affect reimbursement.
The industry is trending toward value-based care, but fee-for-service isn’t going away
Experts at IBM Watson Health expect that valuebased payment will represent 41% of revenue in 2020, up from 25% in 2016, a projection that is supported by multiple sources. But fee- for- service is still expected to represent 48% of payments. Hospitals can prepare for having their feet in both boats by focusing on performance in repeatable episodes of care while continuing to stick to the basics of cost reduction and quality improvement.
Medicare offers a substantial amount of actionable data
Providers looking to impact or understand their MSPB performance should make use of significant data on their facility available from the CMS. Apply groupings to that data: drilling it down to specific diagnostic categories or service lines and applying clinical classifications can help identify variation. Honing in on a specific disease or episode of care can make it easier to identify where variation may lie in the continuum.