Modern Healthcare - - NEWS MAKERS -

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 Mod­ern­Health­ 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.

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