Summary: Are you ready for a shift in risk from payer to provider? Will you be ready for value-based purchasing when it becomes required? Are you utilizing other reimbursement models such as bundled payments, Accountable Care Organizations, and Population Health Management?

From a provider perspective, healthcare reform is aimed at tightening the purse strings, working more efficiently, reducing waste, and improving quality. The shift of risk has begun which will transform healthcare from a fee-for-service to fee-for-value. When the ultimate transformation ends, is still uncertain. As such, fee-for-service is still being utilized and providers are still generating profits and revenue based on the volume mentality while simultaneously trying to transition to a volume and quantity mentality. Juggling the opposite ends of the spectrum is no easy task.

Bridging the Gap Between Volume and Value-Based Strategies

In order to transition successfully, providers need to completely change their mindset and the way they do business – to acknowledge and embrace the cultural, information technology, and clinical changes which need to take place. From a cultural perspective, providers need to review and revise their strategic plan, ensuring buy-in from all levels of the organization from clinical to administrative and from leadership to front-line staff. Additionally, collaboration throughout the organization as well as with external providers and payers is a must. This will involve at the very least an investment in information technology such as electronic health records and health information exchanges to allow instant access to patient information for all applicable entities. Infrastructure may need to be revamped or enhanced to accommodate these new delivery models. Clinically, processes will need to be evaluated for efficiency. Training will need to occur at all levels of the organization. Buy-in from medical leadership will be key.

New Delivery Models

What are the advantages or ultimate goals of value-based purchasing and other new delivery methods?

• Reduce waste
• Reduce unnecessary or duplicate testing/services
• Increase quality and better outcomes
• Shift focus from volume to value and from quantity to quality
• Highlight the critical role of primary care in coordinating care for patients
• Center healthcare decisions around the patient, allowing for two-way dialogue
• Level out the risk between payer and provider
• Ultimately, patients will receive the right care in the right setting at the right time

Healthcare Reform is taking place whether you are ready or not. Beginning preparations before it becomes mandatory will put you ahead of the curve. What are you doing to adjust for the shift in risk and the change in reimbursement? Will you remain profitable or be left behind?

About BHM Healthcare Solutions – www.bhmpc.com

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including healthcare transformation assistance, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

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