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What Is Your Strategy for Risk Based Contracting?


Demands of health care reform are shifting the landscape from a pay-for-service model to a value model. Value will be assessed through a combination of better-served communities, cost controls, and improved clinical outcomes. Healthcare providers throughout the country are faced with the challenge of meeting these goals. One of these challenges, managing risk, takes on a new importance in the face of healthcare reform, particularly when one considers that high-risk populations account for a disproportionate number of healthcare costs and illness.


Inefficiencies in historical treatment approaches, as evidenced by underserved patient populations, escalating healthcare costs, morbidity and premature death rates, point to the need for new directions in healthcare delivery. New demands from many quarters—government, payers, communities, and patients—insist upon value, and new reimbursement policies penalize those who don’t deliver value.


The good news is that significant progress toward transitioning to a value-based provider model can be achieved by adopting key strategic responses that are already yielding benefits among provider organizations that have adopted them. Critical change in areas such as organizational structures, a more patient-centered approach to care, better-informed and better-integrated treatment teams and more effective utilization of Electronic Health Records are called for to meet changing times in the healthcare industry. This article reviews some critical strategies that can make a significant difference.


Horizontal vs. Vertical Organization

More and more providers are recognizing that traditional siloed approaches to healthcare delivery account, in large, to inefficiencies, cost overruns, and gaps in care services. New organizational structures that integrate functional groups that are dedicated to delivering patient-centered services, improve care coordination and information sharing needed to drive improvement in clinical outcomes and financial savings.


Engaged Patient Populations

Limited patient access to primary care accounts for inflated costs and less than optimal clinical outcomes. Improved access to care and more patient involvement in personal health management will address these issues. Providers can facilitate this transition through community clinics, patient education, and tools such as monitoring applications to encourage primary care utilization, personal health management, patient care coordination, and advocacy and a comprehensive patient follow-up program to assess health needs and actively promote ongoing engagement.


Engaged Clinicians

Clinicians at the front lines of healthcare can greatly impact both costs and quality of care. Involving clinicians in the development of new policies and procedures and promoting buy-in, considerably helps clinicians’ willingness to adopt change. Expanding the scope of patient care by creating interdisciplinary teams supported with evidence-based clinical guidelines and clinical decision support places a greater emphasis on the individual patient’s needs and provides comprehensive, coordinated care that improves outcomes at reduced costs.


Electronic Health Records

Enhanced use of EHR will play an increasingly important role in a patient-centered treatment model that manages costs and outcomes. Information integration and interoperability will improve providers’ abilities to assess patient populations, analyze approaches to care, and measure treatment outcomes and total costs. The development of predictive models and point-of-care decision support that include both clinical and financial algorithms will improve providers’ abilities to more effectively improve clinical outcomes and manage costs.

These fundamental shifts in strategic thinking will enable healthcare providers to meet the challenges of delivering value—quality care to more people at reasonable costs.


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