You’ve been hearing about the imminent transition to value-based care for years. Yet if you’re like CFOs and revenue cycle leaders in most of the country, your business is still deeply rooted in the fee-for-service world.
While it may take several years for your market to shift from fee-for-service to value-based care, you can implement several strategies now to help drive strong financial performance during this time of change and uncertainty.
Here are five actions you can take.
1. Accept that value-based payment is on the rise, even if fee-for-service still has a stronghold in your market.
There are clear signs that the transition is underway. For example, members of the Health Care Transformation Task Force, which includes payers like Aetna and Anthem and providers like Cleveland Clinic and Dignity Health, say nearly half of their business is already in value-based arrangements. And by the end of 2020, members of the task force aim to have 75% of their business tied to value.
At the same time, the government has demonstrated its commitment to value-based payment models, even if many are voluntary. Just this past April, the Centers for Medicare & Medicaid Services (CMS) unveiled several new value-based payment models for primary care that will launch in 2020.
The bottom line: Both commercial and government payers are committed to moving more of your business into value-based payment models.
2. Adopt strategies that promote an efficient, robust revenue cycle under both fee-for-service and value-based care.
During this transition period, your revenue cycle team should continue to rigorously monitor key revenue cycle metrics and seek performance improvement solutions that work in traditional and emerging payment models. Revenue recovery tools, for example, can help reduce charity care, bad debt, and uncompensated care and increase your net revenue in both payment scenarios.
And as more care shifts from the hospital to outpatient settings, you’ll want to implement flexible solutions that can be adopted across the continuum of care, from the emergency room and inpatient care to ambulatory services.
3. Embrace back-end revenue cycle management solutions that can improve your team’s performance.
As value-based care becomes more commonplace, your organization should optimize every opportunity to uncover missing or unknown coverage and protect your margins. Eligibility tools can bring efficiency to your revenue cycle by preventing patients from going to collections and improving cash flow.
Medicare eligibility verification, for example, can help you get patients the coverage they deserve — coverage that may have been missed because of a patient registration or identification error, or some other data anomaly.
Similarly, having a defined process in place to qualify patients for retroactive Medicaid can help uncover payment that would otherwise be lost. One note of advice: If you choose to outsource this function, be sure to pick a partner with extensive experience working with state Medicaid systems.
4. Find partners who are willing to share risks as your organization navigates the transition.
One of the tenets of value-based care is that providers are more accountable for their performance. As your organization takes on more risk for its clinical and financial outcomes, it only makes sense to choose companies that are willing to act as contingency partners.
An ideal contingency partner works seamlessly with your existing revenue cycle team and processes to uncover lost revenue — and only gets paid when you do. This means your goals and your partner’s goals are aligned to drive the best possible performance.
5. Ensure your revenue cycle team makes patient experience a top priority as the industry moves toward value-based care.
Improving the patient experience is one of the three goals of the Triple Aim, as described by the Institute for Healthcare Improvement. Beyond affecting your organization’s reputation and repeat business, the patient experience is increasingly tied to your financial performance. In many value-based payment models like Medicare’s Hospital Value-Based Purchasing Program, a portion of payment hinges on patient experience metrics.
This is important for your team to remember because what dissatisfies many patients is not the clinical care they receive but rather the interactions they have with revenue cycle staff after receiving their care. High out-of-pocket costs and persistent collection calls rattle patients and can contribute to a negative experience.
By taking these steps now, you can ease your organization’s transition to value-based care and sustain its financial performance in the years ahead.
Posted May 22, 2019