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Provider Risk Readiness Report - Navigant/HFMA Survey

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Healthcare providers are ready and planning to assume increased levels of risk through commercial payer and Medicare contracting models and Medicare Advantage, according to a new Navigant analysis based on a survey conducted by HFMA.

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Provider Risk Readiness Report - Navigant/HFMA Survey

  1. 1. PROVIDER RISK READINESS REPORT June 2019 Lead. Solve. Grow.
  2. 2. 2 2019 Navigant Risk Readiness Report Overview 112 From Hospitals 58 From Health Systems Respondents 104 Finance VPs, Directors, or Supervisors 66 C-level
  3. 3. 3 2019 Navigant Risk Readiness Report Q. Does your organization currently have the capabilities needed to support increased levels of risk? 27.8% 72.2% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% No Yes of respondents believe their organizations currently have the capabilities needed to support increased levels of risk. 72% 81% vs. 68% More health system than stand-alone hospital respondents believe their organizations are prepared to take on additional risk respondents.
  4. 4. 4 2019 Navigant Risk Readiness Report Q. Is your organization planning to assume additional risk (Ex: Medicare Advantage, Medicare/commercial ACOs) in the next 1-3 years? Of those executives believing their organizations are prepared to take on additional risk: 28.1% 71.9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% No Yes say they’re planning to assume more risk in the next 1-3 years.72% 86% vs. 68% More health system than stand-alone hospital respondents say they’re planning to assume additional risk in the next 1-3 years. Lack of local market demand was cited by more than half of those not planning to take on additional risk. 56%
  5. 5. 5 2019 Navigant Risk Readiness Report Q. Through which model(s) is your organization planning to assume additional risk in the next 1-3 years? (Select all that apply.) 64.2% 56.7% 50.7% 0% 10% 20% 30% 40% 50% 60% 70% Commercial payer value- based contacting Medicare value-based contracting Medicare Advantage of respondents predict commercial payer contracting models.64% of respondents predict Medicare contracting models.57% 75% vs. 58% More health system than stand-alone hospital respondents predict an increase in commercial payer models. 51% of respondents predict Medicare Advantage.
  6. 6. 6 2019 Navigant Risk Readiness Report 34% vs. 21% More health system than stand-alone hospital respondents say their organizations are already part of PSHP. Q. What are your organization’s plans related to launching or partnering on a provider-sponsored health plan? 56.0% 25.0% 15.0% 4.0% 0% 10% 20% 30% 40% 50% 60% No plans for PSHP launch or partnership Already a part of a PSHP Plan to launch/ partner in the next 1-3 years Plan to launch in 3+ years of respondents say their organizations are already part of or plan to launch a PSHP. 44%
  7. 7. 7 2019 Navigant Risk Readiness Report Q. In what areas are you planning to increase investments (financial, labor) to enhance payer collaboration and support increasing levels of risk? (Select all that apply.) 62.1% 56.9% 56.0% 29.3% 6.9% 0% 10% 20% 30% 40% 50% 60% 70% Technological capabilities Physician engagement Member engagement Outsourced capabilities services Other of respondents suggested increasing investments in IT capabilities. 62% of respondents suggested increasing investments in physician engagement. 57% of respondents suggested increasing investments in member engagement. 56%
  8. 8. 8 2019 Navigant Risk Readiness Report Q. What is your top challenge with maintaining risk-based capabilities? 41.8% 23.1% 22.0% 13.2% 0% 10% 20% 30% 40% 50% Operational processes Scale Reporting insights Data integrity of respondents cited operational processes (contract execution, care coordination/ management) as the top challenge per maintaining risk-based capabilities. 42% 28% vs. 15% Almost twice as many stand-alone hospital than health system respondents cited scale as the top challenge.
  9. 9. 9 2019 Navigant Risk Readiness Report Strategies for FFS and Value-Based Growth Providers will inevitably continue to operate in a market primarily driven by fee-for-service (FFS) payments, but the path forward does not have to be an either/or scenario. Provider Strategies for FFS and Value-Based Revenue and Margin Growth Engage physicians to drive clinical standardization through a Hospital Quality and Efficiency Program, a contract between a health system and an ACO or clinically integrated network. Focus cost reduction on more discrete areas, such as post-acute care, pharmacy care, and management of high-risk patients. Emphasize in-network customer keepage by building tight provider network relationships through IT connectivity, a shared referral management infrastructure, and common standards for access, quality, and cost.
  10. 10. 10 2019 Navigant Risk Readiness Report “With most health systems anticipating continued downward pressure on margins, accepting risk can represent a lever for revenue growth - as long as providers clarify internal accountabilities and commit enough of their resources to risk. These results show the value-based movement may be coming full circle, and this time providers will benefit from previous experiences in designing their approach.” RICHARD BAJNER Navigant Managing Director and Healthcare Value Transformation Practice Leader
  11. 11. 11 2019 Navigant Risk Readiness Report “Sharing risk must be a collaborative pursuit between payers and providers. It’s clear that providers have built the capabilities needed to support enhanced levels of risk and are planning to increase their risk assumption in the near future. Both entities need to partner more closely to lessen the gap between the supply of and the demand for risk arrangements in markets nationwide.” KAI TSAI Managing Director, Navigant
  12. 12. 12 2019 Navigant Risk Readiness Report ABOUT NAVIGANT Navigant Consulting, Inc. (NYSE: NCI) is a specialized, global professional services firm that helps clients take control of their future. Navigant’s professionals apply deep industry knowledge, substantive technical expertise, and an enterprising approach to help clients build, manage, and/or protect their business interests. With a focus on markets and clients facing transformational change and significant regulatory or legal pressures, the firm primarily serves clients in the healthcare, energy, and financial services industries. Across a range of advisory, consulting, outsourcing, and technology/analytics services, Navigant’s practitioners bring sharp insight that pinpoints opportunities and delivers powerful results. More information about Navigant can be found at navigant.com. healthcare@navigant.com linkedin.com/company/navigant-healthcare twitter.com/naviganthealth

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