While the industry’s eyes remain fixed on the nation’s capital to await regulatory adjustments on healthcare provision and reimbursement, one thing is certain. Healthcare reimbursement models will shift gradually from the traditional fee-for-service to a value-based system. Value-based reimbursement strives to link payments to patient health outcomes.
According to the Healthcare Financial Management Association, “It requires a proactive clinical focus, in which patients at high risk for disease progression are identified for early intervention, patient education services are expanded, care is coordinated across sites and specialties, and redundant, non-evidence-based treatments are eliminated—all with three key objectives: making patients healthier, providing high-quality care, and reducing the total cost of care.”
Forward-looking hospitals, clinics and physicians are selectively moving forward with value-based contracts to ready their practices for the impending change. The Center for Medicare and Medicaid Services instituted episode-based payments for selective procedures, thereby creating the need for all affected providers to navigate payment allocation. Capitation models deliver a fixed amount of money to care for a defined patient population. Today, however, most opt for a shared savings model that provides incentives to reduce spending on defined patient populations.
These models all place new demands on a practice, motivating practitioners to:
- Broaden their vantage point from individual to population health management while gaining insights on the predictors of desirable and undesirable outcomes
- Develop evidence-based clinical programs that produce consistently favorable health outcomes for the patient population
- Optimize workflows to deliver the right care at the right place at the right time
- Build the analytical framework and measurement tools to assess performance and drive continuous improvement
- Manage costs while providing appropriate care
- Evaluate current and expected returns from investments made in the practice
While few payors require value-based contracts, early experience with the new paradigm pays dividends today and sets the practice up for success in the future. The following steps can help you get started.
