4 Areas to Consider During the Transition to Value-Based Care

By Jon Melling, FHIMSS, Partner, Pivot Point Consulting
Twitter: @pivotpc

Healthcare providers have made big investments in enabling technologies that bring data-driven approaches to care delivery. Some of the clinical and financial IT resources that healthcare organizations have made strides with include:

  • EHR data capture and training to improve clinical documentation accuracy, quality and timeliness
  • Analytics to aggregate and translate raw data across care settings to support productivity and quality improvement
  • Text mining to identify and stratify at-risk patients early in the care process
  • Solutions that support care team collaboration and communication

As healthcare organizations seek to gain further ground on the path to value-based care, continued emphasis on advanced technology adoption and process improvement is essential. Many organizations are now focused on enhancements to their EHRs and other systems to better support the data structures and reporting functionality required to demonstrate quality. Additional data engineering and analytics expertise is needed to implement innovative technologies that support population health management and a better understanding of case level costs.

While every organization begins at a different place and each value-based playbook is different, all healthcare organizations are working to:

  • Break down clinical and financial organizational silos to support better multi-disciplinary care, collaboration and communication.
  • Share knowledge to provide clear visibility into cost and population risks.
  • Build efficient workflows to manage care for different patient cohorts.

Here are four steps to help healthcare organizations in the transition to value-based care.

1) Conduct a revenue cycle operations assessment.
Ensure current systems, people and processes support and sustain the shift in payment focus from volume to value. Conduct a thorough assessment of each step from first referral to final discharge and follow-up care. Review processes, risks, and opportunities with key stakeholders in the care and billing/accounts receivable process. Include assessment of and improvements related to:

  • Patient access/referrals
  • Charge capture and billing
  • Clinical documentation
  • Denial management and prevention

2) Find innovative opportunities to support at-risk and rising-risk populations.
Assess communication, collaboration and partnerships with community providers to better meet patient needs. Understand how at-risk patient populations can be best managed and allocate resources accordingly. Establish a focused provider network for each patient population. Ensure responsibility alignment that delivers care in the most cost-effective manner. Implement one unique program and monitor cost, quality and reimbursement changes for each initiative as justification for continued expansion.

3) Conduct data-driven contracting with payers.
Organizations must know their current risk profile before going at-risk with payers. Organizations should have analytics expertise, be it in-house or outsourced, to understand costs of care and clinical trends across the organization. This will position the organization well during contract negotiations with payors and in managing the lives and care of their patient populations.

4) Engage with patients.
In today’s healthcare environment patient engagement is paramount. Every individual in the healthcare organization could potentially influence patient satisfaction, which can impact reimbursement as well as market perception. Effective communication and engagement should be top priorities for healthcare organizations. Make it easy for patients to do business with the organization via offerings like online scheduling and patient portals accessible across digital mediums. Explore opportunities for multi-modal communication to better engage patients throughout their healthcare journey.

As the pace of change from fee-for-service to value picks up, hospitals must have a tactical plan for managing that transition. It is important to understand current processes and how technology is – or can – promote communications, efficiency and foster innovation. Healthcare leaders who proactively control costs, improve efficiency and communicate and collaborate in care delivery will convey greater value to both patients and healthcare partners alike.

This article was originally published on Pivot Point Consulting and is republished here with permission.