In November, leading health care industry and system executives gathered in Austin, Texas to take part in the HealthLeaders Media CEO Exchange. nThrive was delighted to host a group of participants ranging from small critical access facilities to large integrated systems, engaging them in an intimate discussion on best practices and strategy related to the challenges in migrating to value-driven health care while maintaining current fee-for-service models during the transition.

The nThrive-sponsored event, “How to manage in a post MACRA world,” focused on crucial elements of value and innovation, zeroing in on how health care organizations can sustain critical revenue lines in today’s rapidly transforming value-based health care environment.

Transition to Value

While health care is no stranger to change, MACRA introduces a new set of challenges resulting from the dynamic shift from fee-for-service (FFS) to value-based reimbursement (VBR) models. Led by nThrive Principal Kyle Kobe and Senior VBR Consultant Moshe Starkman, the group discussion centered on ways to identify effective strategies to manage margins while negotiating MIPS and/or other alternative payment models.

Representing both rural and metropolitan communities, session participants agreed that the over-arching question is how do organizations “walk the fence” between FFS and VBR to ensure financial viability while preparing for the future. The consensus was that one-size does not fit all when it comes to a value-based reimbursement model.

For example, for many, the top five success factors include:

  1. Outlining population as it pertains to demand.
  2. Promoting productivity amongst employed physicians.
  3. Mitigating unnecessary resource utilization, including eliminating preventable readmissions and taking advantage of state-of-the-art telecommunications.
  4. Reliable and actionable analytics through sound data and comprehensive reports.
  5. Organizational alignment across the varied levels of governance and roles within each.

Additionally, Kobe and Starkman shared strategies that nThrive clients are implementing to move toward value-based models without an additional, untenable financial burden, including examples of success generated from a focus at the physician practice level. As payments and revenues transition, Kobe emphasized the need to remain ahead of the cost-curve and shift to value-based care in order to mitigate long-term risk and take advantage of currently available incentives.

For example, health care organizations can reduce loss and attain financial performance level goals by leveraging their universe of data to tackle challenges inherent in “riding the fence” between FFS and VBR. By employing analytics technology, organizations can work toward establishing a successful business model to effectively analyze their strengths and weaknesses.

“Ultimately, achieving value depends on effective clinical outcomes, cost control and improvement of the patient experience, fostered through collaboration and engagement of payors, physicians, patients and other stakeholders.” Starkman explained. “Bringing patient information together from across the continuum of care is crucial to successfully coordinate care, reduce variation and improve outcomes. This can only be accomplished through employing sound technology on top of accurate data.” He continued by explaining that the development of collaborative partnerships is essential to successful, cost-effective population health management and arguably is as important as the technology that drives it.

Kobe further noted that organizations will inevitably incur some financial loss in the transition to VBC, primarily due to initial investments in technology and reduction in revenue. However, as the health care industry moves to value models, being prepared will result in earlier ROI and foster an environment that can adapt better to rapidly developing standards and best-practice initiatives.

“At nThrive, we believe discussions such as the HealthLeaders Media CEO Exchange are an important way to facilitate, collaborate and lead the charge together to eliminate health care disparities and deliver exceptional care at a reduced cost,” Kobe explained.

To learn about how nThrive can help guide your path to value, click here.

Want to learn about MACRA? Let us know here.