Three steps: Get ready for risk-based, fee-for-value health care

Leslie CozattReady or not, here it comes — risk-based, fee-for-value health care is here or coming to a market near you!

Health care providers are no longer asking whether they should get ready. They are asking: How fast should we make the transition?

They know it may not be pretty.

“Organizations need to set a goal of being able to do global risk within three to five years,” Dr. Alan Krumholz, former medical director at Mayo Clinic Health System’s health plan, says in the white paper “The speed of transformation: Preparing for the payment models of tomorrow.” 

“Within those years, there will be some moderate gains or moderate losses in that process, because no transition is painless. It’s hard. But on the other hand, they don’t really have a choice. The payer reality is changing.”

It’s true: Transformation can be risky and requires a carefully plotted road map. What’s a provider to do? Start planning for the transformation now and make some investments in it.

Here are three things providers can do now:

  • Optimize care protocols. In short, care needs to make a big switch from reactive to proactive. Keep people healthy so they don’t get sick in the first place. Organizations operating under a fee-for-service contract can find profitable ways to do that. Example: They can promote preventive service to prevent readmissions.
  • Optimize partner relationships. Providers have to map out a route to convert existing payer contracts to value-based models, based on their ability to accept risk. A key part of that is rewarding doctors when they engage and drive behavior that optimizes patient health habits.
  • Optimize IT. Electronic health records and health information exchanges need to be updated. Workflows that use these technologies have to be transformed to promote proactive patient care. Data and analytics are key because they can give organizations actionable data that tells them which patient strategies are cutting costs and improving patient outcomes.

“Managing risk is not what people think it is,” Krumholz says. “Managing risk requires working with providers, aligning their incentives [and] having the data and analytics to know what you’re doing right and to clearly understand what you’re doing wrong.”

For more on how to manage the transformation, download the white paper.

You’ll also read about internal and external factors that can affect your transformation timeline and the risks and rewards of what’s to come.


About the Author:

Leslie Cozatt currently serves as director of Marketing, Optum Provider – Thought Leadership and Content Strategy. She directs the development of content that spotlights the role of data analytics in healthcare – specifically the transition to value-based care, risk management and population Leslie Cozatthealth management. She brings to her role more than 20 years of experience developing B2B and B2C integrated marketing campaigns for companies including ThreeWire, Eliance and 3M. Leslie attended the University of Minnesota and graduated from Wellington College with a BS in international business & communication

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