Vital Preparations for the Shift to Value-Based Models
Ingenious Med provides a best of breed mobile and web solution that increases practice revenue, measures and standardizes organizational performance, reduces unnecessary costs, and promotes care team collaboration. Created in 1999, our physician-designed application streamlines workflows and can be customized to fit the needs of any organization — regardless of where they fall on the volume to value spectrum.
How can healthcare organizations best balance the need to move toward value-based models – while still addressing long-established revenue cycle concerns such as days in A/R and collections?
The shift to fee for value is a long and risky one. The best way to balance fee for service and fee for value now is also the best way to prepare for the transition. Organizations must optimize revenue cycle operations before the shift, baselining what services are being done, acuity, and cost. This is important because many value-based models are based on revenue cycle metrics. Even health systems that are farther along the path to value have a surprising amount of fee for service revenue. Don’t lose the fee for service fundamentals, even as you transition.
What technologies can healthcare organizations use to more effectively deal with emerging riskbased contracts?
Risk is typically associated with cost and quality behaviors focused on certain populations, so healthcare organizations should use technologies that align physicians with those goals. Tools that help reduce readmissions, facilitate collaboration between care teams, and minimize unnecessary and costly bed days should be priorities. Measurement tools that show physicians how they are performing with respect to these key cost and quality behaviors are also critical. No matter what tools organizations select, it’s important that they fit into a physician’s workflow and don’t interrupt care quality. Perhaps most importantly, these tools should empower physicians to make changes to their behaviors, when necessary.
What do you think is the largest blind spot for organizations currently in the transition to valuebased models?
As organizations move to fee for value, you see an increased focus on population health, including chronic conditions, preventative care, and avoidance of disease progression. The goal is to keep people from getting sick, but that number will never reach zero. Another area that doesn’t get as much attention — but can also have a major impact — is the cost when people do get sick. There are many inefficiencies in the acute and subacute space that can be addressed to lower costs without sacrificing care quality. How many patients stay in the hospital longer than necessary because the results from a test didn’t get back to the physician or family wasn’t called to pick them up? By addressing these simple administrative costs, organizations can impact a large portion of unnecessary healthcare spending, in addition to population health initiatives.
How do you expect the federal government’s focus on reducing administrative burdens to have an impact on revenue cycle practices?
Reducing administrative burden should lead to some physician time being recovered. At the same time, however, risk-based contracts require new processes, many of which will now fall on the back office. Because of this new focus and the challenges it will bring, existing revenue cycle processes must be optimized. The optimization of coding, clinical compliance, timeliness and consistency of charge capture, productivity, and denial collections are necessary improvements organizations should focus on as costs continue to rise and the shift to value accelerates.