Vi­tal Prepa­ra­tions for the Shift to Value-Based Mod­els

Health Data Management - - SUCCESS STORIES + STRATEGIES - Dr. Steven Liu, Founder and Chief Med­i­cal Of­fi­cer, In­ge­nious Med

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.

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