The ultimate goal for provider risk-bearing is to develop a system that focuses on local market needs and planning for patient engagement at all levels. To get there, organizations need a comprehensive, strategic value-transformation roadmap—our fifth and final risk-bearing action for provider organizations.
A value-transformation roadmap will define the strategies and priorities to reduce costs that improve care.
- Define population-based and care model path: Based on your population analysis and value-based contracts, update your care model to take into account new reimbursement realities.
- Identify sequence of inpatient cost take-out opportunities: The more costs you can remove from your inpatient expenses—whether by creating efficiencies and or by improving patient wellness—the more you’ll be ready to take on risk.
- Sequence movement into value-based models for all payers and populations: Decide how you will transition your payers into value-based contracts. For example, as mentioned in my post on strategic structure <link to strategic structure post>, Cornerstone Health Care in North Carolina has at least one value-based component in each of its payer contracts.
- Develop a coordinated value-transformation roadmap across capabilities: The roadmap needs to cover the complete spectrum of your organization—primary and specialty, inpatient and outpatient, finance and IT, etc.
For those already following their roadmap, the way is difficult, at times. There are people within such organizations who fight the changes, and there will always be the providers on all levels who are in it for the money.
“The [existing fee-for-service system] has created all sorts of disincentives and misalignment because there is a lot of ‘me’ and less of ‘we’,” said Grace Terrell, MD, Cornerstone Health Care’s CEO. “ We have to design a system that incentivizes everyone to do the right thing for our patients.”
“Risky Business” previous posts:
- Five key actions to establish medical risk-bearing
- Building value-based and market-based models
- Strong leaders, appropriate structure needed
- Population-based planning in provider risk-bearing arrangements
- Planning for financial realities and capacity downturns