There is a major industry shift underway to move toward a value-based care model and away from the traditional fee-for-service model. It’s a little overwhelming to keep up with all the headlines and news feeds about the uncertain state of healthcare in America today, which is why everyone is asking what does this shift mean for the future of healthcare and an increasingly savvy patient consumer?
Why value-based care matters today
One thing is certain: value-based care is the future of healthcare in America, and the ramifications to insurers, healthcare organizations, and patients are numerous. With the passage of MACRA, it’s clear that CMS is leading the charge, and evidence of private insurers following suit is everywhere. Forward-thinking healthcare leaders are starting to align themselves with this changing landscape by focusing on organizational changes that will minimize financial risk. Further, increasing healthcare costs means patients are paying closer attention to — and feeling the burden of — out-of-pocket expenses. As a result, they are shopping around to find the best financial and care value to them as a consumer.
During this volatile time in our healthcare system, now is the time to plan for the future and avoid being a relic of the past. What can you do to get in front of the impending shift? Start by assessing the areas of your organization that aren’t well-positioned for a change to value-based care. For example, ask if your Health Information Management department and Certified Professional Coders are properly trained in ICD-10 to maximize your ability to capture the value of care being provided in medical records and on claim forms. If the answer is no, invest in training and education or find a partner to support you. Make sure your providers are in the know and that they understand how their ability to properly document the care they are providing really matters in this changing model.
Keep an open dialogue
Promote provider understanding by speaking regularly with them about value-based care and the organizational vision to anticipate impacts. Listen critically to provider concerns and assess their ideas to improve outcomes. Explore if your technology is well-positioned to appease an educated and value-driven patient. Take a discerning look at your existing contracts and models and start connecting with insurers about creating mutually beneficial relationships that are progressive in anticipation of value-based care reimbursement.
Ask these 10 questions as your organization shifts toward value-based care
- Do you have tools to offer transparent pricing information to patients at or in advance of the time of care?
- Are your financial policies reflective of the increasing cost burden to patients?
- Have you considered offering fund retainers to even out the financial impact of services to patients and your organization?
- Are you taking advantage of the benefits prompt payment discounts create for patients as well as the financial health of your institution?
- Are you talking to your colleagues and peers about how they are planning and preparing for value-based care?
- Have you connected with the media to create a space to market what your organization is doing to be a thought leader when it comes to value-based care?
- Have you created a culture around the “customer” across your organization by offering call center-based concierge services where patients are able to address all their needs with one phone call?
- Have you explored population health management to understand the data around your specific patient segment and demographics?
- How close to implementing HCC coding is your organization, or are you already implementing it?
- Have you recently had an external coding HCC audit for education?
The Bottom Line
If you’ve been hedging to take action, now is the time to be proactive and not reactive. The change is upon us, and it’s critical to be ready for what the future holds. Consider the 10 questions above and gauge your progress on shifting toward the value-based care model. One of the most efficient measures of action you can take today is to focus on HCC coding to understand the true cost of care for your patient population.