Tawnya Bosko, DHA, MS, MHA, MSHL, Vice President, The Camden Group: Population health-based models’ intent is to improve the overall value of healthcare. We talk about value, but what do we mean? In healthcare, value refers to the overall health outcomes, or quality of health achieved per dollar spent toward achieving that outcome. Thus, value has both a cost and quality component.
Historically, payer negotiations have often centered around volume and per-unit reimbursement increases and certain services have subsidized others. In the new world, financial and managed care professionals must not only understand their cost to provide services but also have a new arsenal of tools, knowledge and interconnectedness with clinical and quality management areas to enable them to “prove value” in order to maximize reimbursement.
Further, operationalizing alternative payment models and incentives within the revenue cycle will require detailed planning and new skills for the team. From pay-for-performance programs to accountable care organizations and shared savings to bundled payments (and combinations of many or all of these) to management of full risk, these value-based payment models will drastically alter revenue flow and management within the system and will require new technologies, revised work-flows, skill sets and training, partnerships, communication and change management in order to succeed. Financial leaders must plan in advance to ensure that their revenue cycle evolves and complements strategic initiatives in support of population health evolution.
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