Steven lash San Diego explain Healthcare Revenue Cycle and the Impact of Value-Based Care

Healthcare Revenue Cycle and the Impact of Value-Based Care by Steven Lash San Diego

The change from fee-for-service to value-based care payments impacts revenue cycle management. • Value-based care models goal is to make healthcare providers accountable for the services they provide to patients, but they are designed to shift financial accountability to healthcare organizations from payors. Many providers are confused on how to align their revenue cycle management strategies with value-based reimbursement. • In a June 2016 survey conducted by Health Catalyst, less than one-quarter of hospitals reported that they are on track to achieve the goal set by the Department of Health and Human Services (HHS) to tie 50 percent of Medicare payments to a value-based payment model by 2018.

• Most healthcare providers are committed to making alternative payment models work. About 23 percent of those surveyed expected to connect half of their payments to a value-based care model by 2019, a year later than the federal goal set by HHS. • In order to be successful and take advantage of the opportunity providers will need to refocus their revenue cycle management strategies to include more data analytics tools, population health management, and better patient billing techniques.

DATA ANALYTIC INVESTMENTS WILL HELP TO MAXIMIZE CLAIMS REVENUE AND TRACK OUTCOMES • Value-based care hinges on care quality improvement.

Providers must invest in data analytics or vendorsponsored systems to analyze quality metrics and monitor their progress with improvements. • Private and government payers are increasingly providing financial incentives in addition to their normal fee for service payments that demonstrate and improvement in care delivery and reduce healthcare costs. However, doing nothing is not the answer as providers can face financial penalties for not achieving quality and cost standards.

Robust data analytics tools will help maximize claims revenue in a value-based payment arena, especially since providers can review their performance in real-time. This will enable them to and improvements to claims management systems. In addition to measuring and maintaining performance, healthcare analytics tools are beneficial for monitoring claims management systems, which will allow modifications as the data comes into view.