Subject(s)
Delivery of Health Care/organization & administration , Economic Competition , Health Facility Administration/methods , Value-Based Purchasing , Contract Services , Humans , Models, Organizational , Organizational Culture , Quality of Health Care , Reimbursement, Incentive , United StatesABSTRACT
The challenges health systems often face in aligning physicians with organizational cost and quality goals related to the delivery of value-based care differ between employed and independent physicians. With employed physicians, the focus should be on right-sizing the service delivery network and employed medical group, building a sustainable compensation program, enhancing the revenue cycle, increasing use of midlevel providers, and implementing a common technology platform. With independent physicians, the focus should be on understanding available contracting models, participating in shared-savings arrangements, considering alternative payment distribution models, choosing the right metrics, and exploring shared branding options.
Subject(s)
Economics, Hospital , Hospital Administration , Physicians/economics , Salaries and Fringe Benefits , Group Practice , Hospital-Physician RelationsABSTRACT
Developing a health insurance exchange strategy begins with: Understanding how both the public and private exchanges work. Conducting a thorough analysis to quantify how exchanges will affect the organization's current and future patient populations and revenue base. Determining when to participate in the exchanges, keeping in mind current market position as well as competitors' actions.
Subject(s)
Financial Management, Hospital/organization & administration , Health Insurance Exchanges/organization & administration , Patient Protection and Affordable Care Act , United StatesABSTRACT
Numerous factors contribute to an organization's "risk tolerance" under performance-based risk arrangements, including its size, patient population, and the strength of its financial position. There are three types of risk inherent in value-based contracting: Financial risk. Actuarial risk. Strategic risk.
Subject(s)
Contracts/economics , Risk Management/organization & administration , Value-Based Purchasing , Economics, Hospital , Reimbursement Mechanisms , Risk Management/economics , United StatesABSTRACT
Before embarking on a physician-integration strategy, hospitals and health systems should perform a detailed analysis of the following four critical areas to ensure that the strategy is competitive and sustainable: Strategic objectives; Financial resources; Requisite experience and functional capabilities; Organizational structure, culture, and commitment.
Subject(s)
Cooperative Behavior , Hospital-Physician Joint Ventures/economics , Hospital-Physician Joint Ventures/organization & administration , Program Evaluation , Economic Competition , Efficiency, Organizational , Hospital-Physician Joint Ventures/trends , Organizational Innovation , Organizational Objectives , Practice Valuation and Purchase/economics , Practice Valuation and Purchase/organization & administration , Reimbursement, Incentive , United States , Value-Based PurchasingABSTRACT
Before taking on value-based care, hospitals must assess risk capacity.
Subject(s)
Risk Management/organization & administration , Value-Based Purchasing , Economics, Hospital , Governing Board , United StatesABSTRACT
Physician alignment will be essential to success under value-based care. Learn the six steps to building long-term, effective integration.
Subject(s)
Hospital Administration/methods , Hospital-Physician Relations , Organizational Objectives , United StatesABSTRACT
Four primary hospital-physician models are per-click service agreements, management services agreements, gainsharing, and equity joint ventures. Four key attributes needed for successful joint ventures are clinical quality, customer satisfaction, operational effectiveness, and financial soundness. Hospitals and physicians need to approach joint ventures with expectations of high performance.
