Atlantic Health is looking to expand its value-based care footprint over the next three years, building on an already sizable foundation of risk-based contracts as it balances growth ambitions with policy uncertainty.
Saad Ehtisham, president and CEO of Morristown, N.J.-based Atlantic Health, said about 38% of the system’s revenue currently comes from risk-based arrangements. The system operates two large accountable care organizations and is aiming to increase that share to the mid-40% range.
Atlantic Health’s population health strategy was set when Mr. Ehtisham arrived earlier this year, and he sees room for additional expansion.
“I’ve challenged the team in the next three years to try to get from 38% to, 43% or 45% of total book of business of value-based care,” he said during an interview with the “Becker’s Healthcare Podcast.”
At the same time, Atlantic Health is taking a cautious approach given potential regulatory and policy changes that could affect reimbursement models.
“You have to be cautious there because we don’t know how the policy is coming from the administration going to pivot and change,” Mr. Ehtisham said.
Atlantic Health’s payer mix reflects broader industry trends, with roughly half of its revenue tied to government programs including Medicare, Medicare Advantage and Medicaid. The system also has a portion of its patient population who self pay. The remainder of Atlantic Health’s revenue comes from a mix of managed care contracts, which creates opportunities on both the government and commercial sides of the business.
Technology and automation are expected to play a supporting role in Atlantic Health’s value-based care strategy, particularly on the administrative side of the organization. Mr. Ehtisham pointed to areas such as coding and denials management as opportunities to reduce manual work and improve efficiency.
“There’s technology out there, including artificial intelligence that can mine the electronic medical record and code the medical record ready for billing,” he said.
There are many AI applications and platforms available to alleviate the administrative burden within the revenue cycle, but humans still play an important role in the process. The goal is not to eliminate human oversight, but to allow staff to work more efficiently.
“You leverage the ability of one coder to be able to do multiple, multiple, things at the same time without having multiple coders doing singular things,” Mr. Ehtisham said. “You’re parallel, processing.”
Ultimately, the system’s push toward value-based care is tied to improving outcomes while lowering costs for patients.
“To achieve better outcomes at a lower cost is eventually going to lower the out-of-pocket burden on our consumers,” Mr. Ehtisham said. “That’s really the endgame.”
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