Are you ready for the value based payment model?

March 15th, 2016 - Victoria   
Categories:   Claims   Practice Management   Reimbursement  
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Healthcare professionals are being forced to move out of their comfort zones. Sweeping changes are being made to change the way healthcare is provided and paid for.
40% of in-network payments are tied to value. And the traditional fee for service model is expected to disappear over the horizon in the years to come. Payments based on quality of care are increasing and it is imperative for healthcare organizations to address the current, on the ground, challenges, posed by the VBP model.

The 3 big challenges on the road to value based payment are…

1.Compensating physicians based on value        

For years physicians have been reimbursed based on the volume of services, and a huge part of a doctor’s income is based on FFS contracts. It is a perplexing problem as there are several compensation forces at play. As reimbursement trends slant in the direction of value based payments, physicians will have to be incentivized for meeting pre-determined performance goals rather than for the volume of services rendered.
Going forward, healthcare organizations should track the performance metrics of physicians. Individual performance scorecards will have to be maintained. Extensive documentation is needed to prove demonstrable, increased efficiency in better performance. Physician compensation mechanisms need to be updated to align with the changing reimbursement environment.

2. Access to updated data

Tracking and analyzing huge volumes of data in the controlled chaos of a healthcare organization is an uphill task. But it has to be done; there are no two ways about it. Why? Because a majority of value based incentives are based on several quality parameters.
Intuitive and user-friendly data analytic solutions are the need of the hour. Organizations will have to measure and monitor quality performance closely and continuously. They need a system that helps them view key data in a single, integrated system rather than looking for data in various repositories. Interpreting data and translating it into workflow improvements is the need of the hour.

3.Improving operational costs

Providers will have to eliminate redundant and ineffective processes. In the value-based climate, streamlining workflow processes and eliminating waste is of utmost importance. Every single reason for waste has to be systematically identified and weeded out. To do that, providers will have to understand their operational costs in granular detail.

To reduce waste and improve workflow efficiencies, healthcare organizations should…

Adopt a data analytics system that helps them identify where the faultlines are
Analyse areas of variation and waste
Join hands with physicians to drive up process improvements
Track financial and operational metrics closely

The way forward…

Healthcare organizations have a tough job on their hands. Better documentation, more streamlined workflow processes and containing operational costs, top the agenda of healthcare organizations. Though the path towards value based payments appears to be bumpy, the destination it promises could well be the solution our broken healthcare system desperately needs.


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