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There is a great deal of discussion and analysis about the shift to value based care as healthcare payers – employers and health plans — contemplate new models of care. The Department of Health and Human Services (HHS) is already driving the change – by setting a goal that 30 percent of fee-for-service Medicare payments be tied to quality or value through alternative payment models (such as bundled payment arrangements) by the end of this year, and 50 percent by the end of 2018. Is your organization ready to make the move?
Truven Health has been consulting with payers on everything from their payment strategy to their risk tolerance, and we’ve learned that organizations are in varying stages in their journey to value based payments. Some are very far along, some are just starting, and others are unsure of where to start. In helping payers think about their journey to value-based care, we’ve developed some guidelines on how to begin.
If your organization is just beginning the journey, we recommend you ask yourself a few key questions:
● What are our biggest opportunities and challenges? Have we validated potential financial and operational risks?
● Do we have adequate market and volume to justify the investment and minimize risk?
● How are we aligning with physicians to support adoption and population health management needs?
● Does our approach support our identified value based payment model strategy and objectives?
● Is our strategy agile and sustainable as new models continue to emerge?
A thorough assessment of your readiness for a new payment strategy should include:
● Analysis of your proposed payment model, including design implications, incentive structures, quality, provider alignment, and integration
● Evaluation of your opportunities, challenges, and readiness to implement bundled payment definitions and pricing
● Review of your performance measurement reporting, including gaps and an impact analysis
● Assessment of data feed adequacy, quality, and clinical and financial implications
The journey to value-based care and payment will not happen overnight. Payers and providers will need to collaborate, learn, and adjust their approach to various approaches before finding their best fit. The key is to have information and analytics to support the process, and a partner with holistic and deep experience across the entire claims and revenue lifecycle.
For answers to your questions about value-based payments, or for help devising a payment strategy, contact us at firstname.lastname@example.org.