OM: Preparing For Value-Based Reimbursement—Even Before The Contracts Are Signed

Preparing For Value-Based Reimbursement—Even Before The Contracts Are Signed

by Sarah. C. Threnhauser Open Minds August 18, 2018

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This week, I've heard a lot of conversations about value-based reimbursement (VBR) that have ranged from, "We don't have the ability to track, let alone report, these types of performance measures", to "we're as ready as we are ever going to be." But the big question is what should executive teams be doing now to ensure that their organization is positioned and prepared for VBR, even if they don't have risk-based contracts yet.

OPEN MINDS advisory board member Ken Carr answered that question at The 2018 OPEN MINDS Management Best Practices Institute...Mr. Carr shared three steps to keep the momentum moving forward in preparation for value-based payment.

First, he suggested that provider organization executive teams need to ensure that their strategic plan includes initiatives that will move the enterprise toward value-based reimbursement readiness. If you're doing scenario-based planning, this is likely already part of your planned scenarios for the future. In particular, this means focusing on three aspects of readiness:

  1. Strengthening relationships with payers and health plans—Build trust with payers by delivering results in fee-for-service (FFS) contracts and pilot projects is an important way to develop working relationships that will be needed later to tackle larger opportunities together.
  2. Improve revenue cycle effectiveness—With one foot still in FFS and the other stepping toward VBR, revenue cycle management is critical. Organizations need to show they can do FFS well before adding value-dependent payments to the equation.
  3. Implement the state-of-the art technology needed to create a data-driven culture—Gathering relevant data, analyzing that data, and adapting services based on the data to achieve outcome goals is essential to sustainability with VBR.

Second, Mr. Carr recommended that executive teams need to focus on assessing the talents and culture of their team. All staff must understand and embrace their role in delivering quality services with the most efficient use of resources. Talent, or the lack of talent, is what sets one organization apart from another. It is a key ingredient of organizational brand management and competitiveness and comes down to two essential components:

  1. Insure you have the right staff, and that your staff have the right skills—The skills necessary under a value-based reimbursement business model are different from a FFS model. Focus on customer service, engagement and activation, motivation to achieve outcomes, and tech skills to understand and use data are all important skill sets to master.
  2. Attract the best talent—Inbound marketing (based on online marketing reputation) will assist in the process of attracting, engaging, converting, and tracking a talent pool of potential staff.

And finally, Mr. Carr outlined the need for strategy execution, which puts the strategic alignment decisions and talent together to actually move the organization to readiness. Executing your plan to move VBR forward has three key components:

  1. Educate all staff on the role of value-based reimbursement—It is essential for staff to understand the relationship between customer service and financial results; and how their role within the organization helps to create value for consumers, payers, and the organization. It also ensures ongoing focus on the move to VBR and prevents staff from straying away to other perceived priorities.
  2. Ground all project planning “in reality”—A plan without implementation details is a plan that will fail. A strong plan should identify what resources will be needed, where those resources will be obtained, and how they will be managed.
  3. Construct dashboards around the project plan—Continuous monitoring of key metrics will enable the organization to monitor whether it is achieving the key readiness initiatives on anticipated timeline. Variations identified in the dashboards will provide opportunity to adapt activities before losing momentum.

Mr. Carr summed up the challenge of moving to value-based reimbursement care, saying, "Moving to a place of readiness for value-based purchasing is a complex process that involves multiple changes in the organization—culture, staffing, workflows, and processes. Taking time to integrate the plan into strategy, assess and onboard the right talent, and stay focused on execution will be necessary to move the organization to readiness."

For more live coverage from The 2018 OPEN MINDSManagement Best Practices Institute, be sure to check out our live coverage of the event on Twitter @openmindscircle — #OMBestPractices.