DHG Healthcare, a company that provides advisory and accounting services to the healthcare community, has released a report detailing challenges in developing a clinically integrated network.
Here are three challenges clinically integrated networks are currently facing that were mentioned in the report.
1. Shift of risk from payer to provider
Healthcare reform is shifting risk to providers by incentivizing hospitals, health systems and physicians to manage the health of the population they serve. Commercial payers are aggressively following suit to implant incentive and risk-based payment models which requires transformational change in how providers deliver care and forces hospitals and physicians to align more closely.
2. Movement from volume to value
Physicians and health systems are being affected by recent cuts to fee-for-service reimbursement as well as uncertainty related to Medicaid expansion and health insurance exchanges. As mentioned above, payers are moving from a volume-based, fee-for-service model to a value-based model that pays based on performance and population management – placing more emphasis on the quality of care rather than the number of cared for.
3. Competition in quality
Quality has become a competitive priority for hospital and health systems due to insurance exchanges and tiered insurance products. The pursuit of quality in healthcare by offering definitions of quality and collecting, analyzing and sharing performance data is commonly limited by a lack of a clear definition and adoption of quality metrics and access clear, transparent performance data. It has also become even more imperative to gain an in-depth understanding of cost and outcomes data.
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