New rules for optimizing health care financial performance

Mention “performance” in a health care context and it brings to mind different images for different people. For physicians, it may mean providing the best care possible. To a provider organization’s executive team, it may be defined by financial success due to operational excellence. Each perspective is valid.

Health care organizations across the country are grappling with the same goal: leave volume-based care behind and embrace a value-based care system. This requires assurances that operations at all levels of the organization are running efficiently.

Optimizing performance is the first phase of the journey toward value-based health care. In the new Optum eBook, “Beyond the Curve of Health Care,” we outline five distinct steps that affect performance:

  • Patient accessBeyond the curve
  • Clinical care
  • Medical necessity
  • Coding and documentation
  • Reimbursement

A person’s ability to obtain health care services impacts them well before they are admitted to a hospital — and for years to come after they are discharged. The patient-access continuum is the responsibility of each organization and the choices they make for every patient.

Let’s not fool ourselves: patients’ expectations about convenient and affordable access to care services are growing, even as costs rise. Consumers are also becoming more interested in their conditions as more information becomes available. They will seek out providers who can integrate care and health information with other providers. This way, every touch point — now and in the future — is studied and integrated into overall care. As consumers make patient access more complex, there are four main areas to consider:

  • 24/7 access — Via Internet, phone or in the hospital, patients want support and information from medical experts who can provide feedback based on their specific needs
  • Data consistency — Many patients, especially those with chronic conditions, have multiple doctors. To ensure proper care, information must move seamlessly among medical staff members
  • Operations/transitions — As patients move from one care format to another, they want their health to remain a top priority throughout the transition. Using technologies that support patient-access work flow can help improve communication
  • Facilities — From location to staffing to utilities, medical facilities and their staff must be able to serve the patient population without interrupting or hindering care

In our next post, we’ll discuss the another area of optimizing performance: clinical care.

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