The landscape for risk-based contracts has shifted, with value-based reimbursement rising among physicians. However, there are still hurdles for accountable care teams to overcome before negotiating this new shifting landscape.
In a recent presentation at HFMA’s 2015 National Institute, John Wallace of McKesson and Dr. Jerry Floro of Pioneer Medical Group identified how the landscape has changed for today’s healthcare financial leaders. Now that this shift has been identified, what can physicians do to find success with new payment models?
What will it take to succeed?
Wallace and Floro noted that the market has already been charting its needs, giving healthcare financial leaders a path to follow. When gauging success with risk-based contact management, keep these three market mantras in mind:
- Practice growth
- Focus on patient recruitment and retention, while developing a network of participating physicians.
- Focus on physician revenue cycle management, administrative management, data collection and supplies.
- Focus on care coordination and disease management, patient engagement, and population and actuarial analytics.
Given this roadmap for success, Wallace and Floro then charted four foundational pillars for physicians to follow:
- Planning and Strategy
Build the transformational road map with the strategy and planning required to navigate the local landscape of providers, facilities and payers and develop a clear path to success.
- Network Development
Integrate and develop a clinically integrated network of primary care and specialty physicians and high-quality, low-cost facilities to actively participate in a streamlined care delivery model. The network’s technology platform should be interactive at the point of care and automatically inform physicians which providers she should refer to and why.
- Practice Transformation
Transform with the experience that comes from expert professionals who provide hands-on services, so doctors and staff begin making adjustments in patient flow and care delivery needed to thrive in dual fee-for-service and value-based reimbursement environments.
- Care Coordination
Achieve clinical success by tracking and communicating patient care across the care continuum, including transitions. Employing managers, nurses and nursing assistants for care coordination, oversight and utilization management is a vital component of fully transforming a practice.
In additional to these four key pillars, an underlying foundation of insights spans across the entire process. Wallace and Floro call this “population health insights,” where transformation is supported by the ability to bring sources of disparate data together and turn it into useful information.
“I live in the services world,” Wallace said. “We care that we’re getting the right information at the right time. Are our physicians getting the right information to act as close to the point of care as possible, and are we getting retro information coming back in that allows our strategy teams and our managers to close gaps where we’ve seen them historically? We call it population health insights.”
Learn More about Accountable Care Management
While the landscape has shifted for risk-based contracts, these four pillars should help physicians navigate the new rules while providing the best possible care. For more information about accountable care management, download a special value-based care report from McKesson on an 11-year risk-sharing arrangement under Medicare Advantage.