Modern Healthcare - - NEWS -

While the fu­ture of health­care re­im­burse­ment is un­clear, rev­enue growth is still pos­si­ble. In a Sept. 14 we­bi­nar, ex­perts from Tru­ven Health An­a­lyt­ics, a part of IBM Wat­son Health, dis­cussed how providers can con­tinue to grow rev­enue un­der fee-for-ser­vice while gear­ing up for suc­cess un­der value-based care.

Dr. By­ron Scott, as­so­ci­ate chief med­i­cal of­fi­cer, and David Jack­son, vice pres­i­dent of pro­fes­sional ser­vices, led the we­bi­nar, which can be ac­cessed at www.mod­ern­health­­ingRev­enue.

Providers need to learn how to strad­dle be­tween fee-for-ser­vice and value-based care

Re­gard­less of con­gres­sional ac­tion, it’s ev­i­dent that the cur­rent ad­min­is­tra­tion is un­likely to main­tain the same lev­els of cov­er­age ex­pan­sion that were es­tab­lished as a part of the ACA. Pres­i­dent Don­ald Trump’s ad­min­is­tra­tion has al­ready rolled back sev­eral CMS value-based care ini­tia­tives, in­clud­ing the Com­pre­hen­sive Joint Re­place­ment model and an­other bun­dled pay­ment pro­gram for Car­diac care. Re­gard­less, value-based care is here to stay, and providers need to pre­pare for it while en­sur­ing suc­cess in the present.

Un­der­stand the dy­nam­ics of your mar­ket

Com­mer­cial pay­ers rep­re­sent a dis­pro­por­tion­ate share of mar­gins for health sys­tems, so it’s im­per­a­tive that providers un­der­stand where they stand in their mar­ket. It’s cru­cial that lead­ers lever­age data an­a­lyt­ics to bench­mark your rates and qual­ity met­rics against your com­peti­tors. As health plans ex­per­i­ment with nar­row net­works and value-based agree­ments, sys­tems need to en­sure they’re com­pet­i­tive and en­gag­ing pay­ers about these strate­gies. They should also proac­tively en­gage large em­ploy­ers, who can dis­rupt the mar­ket with closed net­works, which can direct thou­sands of pa­tients into (or away from) a health sys­tem.

Im­prove access for consumers

While it seems ob­vi­ous, it’s im­por­tant for providers to make it easy for pa­tients to seek care. That means al­low­ing pa­tients to sched­ule vis­its through on­line por­tals and in­creas­ing af­ter-hours access through ur­gent care cen­ters and pri­mary care clin­ics. Con­sider in­vest­ments in tele­health, es­pe­cially for cer­tain high-risk pop­u­la­tions that may be less able to get to clin­ics or the hos­pi­tal, and im­prove trans­parency with consumers, through cost cal­cu­la­tors and other tools that in­form pa­tients that are tak­ing on an in­creas­ing share of their health­care costs.

De­ter­mine risk and ex­po­sure un­der both fee-for ser­vice and value-based care

Lead­ers should know how much rev­enue is tied to both fee-for-ser­vice and value-based care mod­els re­spec­tively, how uti­liza­tion un­der each model im­pacts end vol­ume, and how each model uniquely af­fects top and bot­tom lines. This re­quires a com­plex set of clin­i­cal and fi­nan­cial data that can ma­nip­u­lated to un­der­stand how var­i­ous strate­gies could af­fect your or­ga­ni­za­tion. It also may re­quire access to data out­side of your net­work from am­bu­la­tory and posta­cute providers.

Em­power physi­cians to do their jobs ef­fec­tively

Health sys­tems should en­sure physi­cians are equipped with a ro­bust elec­tronic health-record, op­ti­mized work­flows and train­ing to pre­pare for MACRA and MIPs. It’s es­pe­cially im­por­tant to en­gage af­fil­i­ated physi­cians who aren’t em­ployed by your health sys­tem by mak­ing it easy for them to re­fer pa­tients into the health sys­tem for di­ag­nos­tic tests and other pro­ce­dures, to en­sure pa­tients don’t go to a com­peti­tor.

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