For the past several years, the U.S. health care industry has undergone a significant transformation in its payment structure, with many organizations evolving from supporting the current fee-for-service to a value-based payment model. A 2015 U.S. Department of Health & Human Services news release articulated its support for a new model when it set a goal of “tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models … by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.” The big insurers are also pushing value-based contracts with providers, and have announced plans for more of these types of contracts.
A new resource to help in the transition
As health care shifts to fee-for-value payments, the organizations that will likely thrive are those whose leaders embrace the changes.
RISKMATTERS,a new publication from Optum, is a resource for health care provider executives beginning or in the middle of their organization’s transformation to managing risk-based financial models, providing support and tips to successfully accelerate their risk-enablement efforts. It focuses the conversation on risk by sharing industry news and executive insights on the shift to risk-based models from various angles. In addition to the quarterly magazine, executives can visit a web site featuring new content each month. RISKMATTERS also celebrates early successes and shares insights learned from health care executives pioneering the way from organizations like Steward Health Care, in addition to stories of providers just beginning their transformation, such as Vantage Cancer Care Network.
The latest conversation: Becoming data rich, insight strong
The availability of big data and analytics is at the forefront of the conversation about moving to value-based payment models, and thus risk-based operating models for providers. By combining the right comprehensive patient data with sophisticated analytics, it’s possible to uncover insights that can support true population health management, enabling providers to take on the clinical and financial risk of caring for patients.
What sounds easy in theory, however, is often difficult in practice. As a health care leader, it’s important to ask tough questions about your organization’s capabilities: Is your organization able to put the insights from data and analytics to best use once you have them? Can you make your data truly actionable, not only for clinical intelligence, but also financial and operational decision making? Asking these questions and analyzing the answers will get you started down the right path in successfully moving to a risk-based model.
The spring edition of RISKMATTERS addresses the use of insights gleaned from data, with special focus on providers that are not only data rich, but also insight strong. You’ll also find content that covers the process of identifying and managing care for the population, as well as applying analytic insights to payer contracting, provider network management—and the entire operations of—a risk-bearing, provider organization.