A report from the American Hospital Association concluded that although quality and outcomes are gaining prominence in determining revenue for healthcare organizations, determining how to apply them in new reimbursement models is not always clear.
Hospitals must remain nimble to adapt to new developments and change plans when necessary, the report says.
“Hospitals and health systems — influenced by both policy and market forces — are increasingly moving away from fee-for-service payments toward value-based arrangements,” the Trendwatch report says.
“There is no single model that will work for every organization. Hospital and health system leaders should assess the personnel, infrastructure, and other capabilities required for success in each model when considering the most appropriate path for their organization.”
The report offers these takeaways on transitioning to value-based payment (VBP):
- “The movement to VBP is being driven by a combination of rising healthcare expenditures, declining reimbursement for Medicare and Medicaid, federal and state policy, market competition, and payer dynamics.”
- “There is no ‘one-size-fits-all’ approach to VBP for hospitals and health systems — leaders will need to assess the most appropriate model for their community and organization.”
- “Past experience with VBP arrangements, organizational capabilities and culture, and market and policy forces influence the ability of hospitals and health systems to succeed in shared savings and population-based VBP models.”
Because individual and group incentives are different from fee-for-service models, some hospitals and health systems have found that moving to VBP requires changing the organization’s culture, the AHA report notes. “These efforts may include changing the organization’s governance and reporting structures and ensuring that clinicians are engaged and represented in leadership roles,” it says.
The report emphasizes that even when hospitals and health systems determine a value-based “destination,” that may have to change over time.
“Leaders will want to frequently revisit their vision and objectives to assess which model may best help them achieve organizational goals and understand the tools, information, resources, and delivery network required to succeed in a particular model.”
The full report is available online at: http://bit.ly/2jOrbh1.