The ground is shifting beneath the feet of healthcare leaders. The United States is inexorably moving toward value-based care, requiring healthcare organizations to start laying the foundation for more holistic, proactive, and population-oriented care. But today’s margins depend on the “piece work” model of fee-for-service, treating people primarily when they are already sick.
How can healthcare organizations address both simultaneously? Well, the good news is that they are not mutually exclusive. Here are three suggestions for success.
#1: Understand the rules of the game
Make no mistake: traditional fee-for-service revenue cycle management (RCM) is still what pays the bills. But population health-style models of care delivery and financing are the end game. For now, healthcare organizations need to be really good at RCM fundamentals. Arguably, they need to be even better than before, since they may need to absorb penalties associated with value-based initiatives.
Moving toward population health models will require significant investments and almost revolutionary levels of change. These may not necessarily pay off immediately. However, if done well, they can help organizations move toward other goals at the same time. In the short term, improving the effectiveness of care delivery processes will benefit the bottom line in a few ways. It will allow enterprises to:
- Avoid payer-assessed penalties
- Capitalize on incentives from bundled payments and shared savings programs such as ACOs
- Manage excess utilization, such as patients remaining in acute settings longer than necessary and emergency department overuse
And what about the long term?
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