FIVE TAKEAWAYS
GROWING REVENUE IN TIMES OF UNCERTAINTY
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.modernhealthcare.com/GrowingRevenue.
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.