The time to transition from fee-for-service models to value-based care (VBC) models is here, as those that continue to delay will be left behind! Many health systems have taken a wait-and-see approach to VBC, but growth in these payment models continues, and in 2020, more reimbursements will be tied to VBC than traditional reimbursement models.
Healthcare organizations (HCOs) must augment traditional revenue cycle processes and optimize care delivery throughout the patient journey to grow in value-based economies. HCOs must monetize downside risk using a three-pronged approach. Strategies for value-based care must:
- Engage with patients to guide them to the appropriate place of service. Develop a digital front door strategy that creates high-touch digital channels to control the inflow of patients and influence where patients seek care throughout the care journey. HCOs should leverage key strategies and analytics to identify high-risk patients and assign care management teams to engage with them to reduce overuse of the ER and lower medical expenses.
- Empower providers with actionable insights to control costs. Computer-assisted clinical documentation boosts productivity, improves accuracy of coding, and helps clinicians capture clinical specificity to increase revenue. Clinical variation analysis can improve length-of-stay trends and reduce costs related to duplicate tests and improper drug selection. In both cases, providers need access to these actionable insights at the point of care.
- Automate mundane revenue cycle tasks to improve financial performance. HCOs should focus on robotic process automation (RPA) when it comes to revenue cycle management to automate prior authorizations and eligibility checks; reduce discharged, not final billed (DNFB) logs; and support office staff with scheduling. RPA bot factories can check claim statuses and update central reports on behalf of coding staff, completing work equivalent to several employees per year.
Read more in our new report, “How To Protect Your Future Healthcare Revenue Streams,” a revenue cycle strategy guide for healthcare providers.
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