A volume to value transition has begun as hospitals and physicians face decreasing healthcare payments. As a result, they will begin to receive less pay per increment of service, which leads to the potential to force some out of the market. On the upside, payment deduction compels quality to move to the forefront. However, quality-focused healthcare produces some major challenges for a value-based system.
With this shift from volume to value, a traditional acute-care fee-per-service system will be the primary model. This will lead to certain challenges:
• More performance-based fee-per-service contracts
• Pressure to keep costs down
• Hurdles to get performance bonuses
• Difficult transition time
The key to undertaking these challenges is chronic disease management. In fact, 75-80% of healthcare costs are related to one of six chronic diseases—diabetes, congestive heart failure, coronary heart disease, asthma, depression and obesity. Acute care providers, such as hospitals and physicians, weren’t trained to address wellness and prevention health management issues that chronic disease patients need. Thus, public policy shifts must follow in order to address the needs of chronic patients and payment support.
An additional opportunity is technology. In order to successfully manage the health of the population, a good information system is vital to tracking patients over time. Some examples include:
• Information technology: provides electronic health records for providers and consumers; helps consumers to become better educated
• Clinical technology: inventing new tools to enhance patient care
• Telemedicine: changes venue from bricks and mortar to digital
• Big data: has the capability to make improve diagnostics and treatment
Watch the three-part video series, “Raising the Bar,” featuring Don Seymour and Dr. William Jessee, to further learn how to thrive in today’s evolving healthcare environment: www.integratedhealthcarestrategies.com/payrisk