1. As CMS continues to forge the journey towards
Value Based Purchasing (VBP) providers, hospitals
and systems seek to attain, and then sustain the
“triple aim” in Healthcare (Population Health
Management, Decrease Per Capita Cost, and
Improve the Experience of Care.)
CMS has determined and released a timeline for
conversion from Fee- for- Service (FFS) to Pay -for
-Performance (PFP). Currently 20% of Medicare
services are value-based, by 2016-30% of claims
need to be PFP and in 2018, a solid 50% will
be required. This means a large percentage of
Medicare beneficiaries will be transitioned to these
new models. Further complicating this charted
course is the looming large and yet pending,
national conversion to ICD-10 which has been
delayed more than once to date.
Models Are Changing
The move from FFS means that Medicare patients
will soon become part of a VBP model (e.g., ACO’s,
Patient Centered Medical Homes {PCMH’s,}) these
outcome based, reimbursement models necessitate
a new level of coordinated care and communication
within the continuum. The reimbursement stakes
are raised by increasing percentages being based
on the patients’ experience of care (surveyed
through CAHPS ®.)
Now that CMS’ readmission penalties are becoming
more than a nuisance (up to 3% may be at risk,)
and in 2014, 2,610 hospitals have incurred said
penalties; some providers and facilities are looking
to coordinate care with pharmacies that can help
reconcile and mange (facilitate & report back)
medication compliance, track and share population
health data, and take care of the follow-up phone
calls -made to the patient at Day 1, 3, 10 and 30.
Providers tend to agree consumers are usually
more compliant with prescriptions if they have
them upon discharge- or can get them onsite.
With an enhanced focus on appropriate access
and utilization, healthcare service providers are
squarely in the hot seat of delivering coordinated
care across multiple platforms; while educating and
engaging their growing patient base with less time
and fewer resources. All this, while consumers
demand a higher level of compassionate care
delivered how, when and where they want to
be treated.
Education and Engagement
Many of today’s healthcare consumers don’t
understand core concepts of their healthcare
coverage, and their newfound coverage doesn’t
guarantee appropriate access. For many
consumers that do understand the financial
responsibilities of a $6,000.00 family deductible-
they may delay seeking treatment, until emergent
care is needed-therefore receiving high resource
intensive care in an inappropriate treatment setting
(e.g., chronic &/or comorbid conditions such as
diabetes and heart disease being treated in the ED.)
The key for providers, hospitals and systems is
to jumpstart their patient facing education and
engagement today, many times by extending the
continuum of care into the front of the office. For
many revenue cycles, battles are won and lost at
the front line (i.e., Pre Access Staff.) They can also
ensure their patient accounts representatives have
the communication skills needed to work with
peoples two biggest triggers: their health and their
money. Many times, simple tools like roleplaying,
sample scripting options, and incentivized
collection contests empower employees to ask for
that co-pay, co-insurance (coin) and deductibles.
Patient Portals are good for more than taking
payments and scheduling appointments; they can
also effectively and efficiently educate patients
about their condition or disease, define commonly
misunderstood health and financial literacy terms
and generally engage consumers from their
smartphones while they wait in your lobby, or
at their house, or anywhere else the internet
may reach.
From Volume to Value, Part 2
Author: Cally Christensen, Inside Business
Development
March 25, 2015
