As the healthcare revenue mix continues to undergo unprecedented transformation, providers are under increasing pressure to make a transition from the fee-for-service payment model to a value-based care reimbursement system.
Navigating that conversion is a lot more complicated than buying new software and sending out a memo to the staff. To be successful in the transition, a number of important elements need to be in place. Some providers already have many of these elements in place, though others are lagging behind.
Arguably the most important element required for value-based reimbursement is interoperability, the ability for a provider to share clinical and financial data both within its own network and with other hospitals or private practices.
In a recent survey of healthcare finance executives by the Healthcare Financial Management Association to assess readiness for value-based payment, nearly 70 percent of respondents cited interoperability as the most important capability in three years.
But respondents also said interoperability was the biggest weakness among key elements needed for value-based reimbursement, with more than half anticipating their organizations’ interoperability will be insufficient three years from now.
Other important elements that providers should have in place are:
Real-time data access and business intelligence.
Real-time access and sharing of data is much of what puts the “value” in value-based care. Clinicians and front-office workers can instantly share data at check-in and the point of care, reducing clinical, coding and billing mistakes.
Business intelligence software provides insights into revenue cycle operations, enabling provider financial decision makers to improve processes, increase payments and reduce expenses. This is especially critical for organizations trying to embrace a reimbursement system still in its infancy, even as they also continue to bill some procedures under fee-for-service.
Finally, in addition to analyzing internal processes, business intelligence software can be used to assess value-based contracts in terms of return on investment.
Care standardization and coordination.
Under a value-based reimbursement model, providers must ensure they have an IT infrastructure that supports standardized care processes in order to maximize successful patient outcomes.
Coordination of care and sharing of patient clinical and payment data is essential to quality post-charge follow-up and chronic care management. A proactive patient follow-up can reduce readmission rates, while software that helps improve care for patients with costly chronic diseases can save money while improving outcomes.
Shared savings programs.
These arrangements can pay off in the form of reimbursements if providers meet spending reduction targets while improving quality care. Shared savings bonuses can be invaluable to providers straddling two payment systems and facing potentially unstable revenue cycles.
Getting it right from the start.
As providers journey from fee-for-service to value-based reimbursement, they will be treating some patients under one system and others on the second. This makes verification of patient eligibility for value-based payment a crucial first step in the revenue cycle process.