Managing Financial Risk Through a Value-Based Clinical Care Delivery System

In days past, hospitals, healthcare systems, and their medical staffs could afford to exist in separate but parallel tracks, intersecting only when necessary to deliver clinical care. As value-based reimbursements, especially those involving both upside and downside risk, become more standard, and providers realize that risk is shifting onto them, they must learn how to manage risk more effectively. Now, throughout healthcare, providers of all types face the overarching challenge of improving value (quality per unit of cost) for the consumer of services, an integrated approach is not only preferable but necessary for success.As payers and self-insured employers roll out MACRA (MIPS and APMs), Bundled Payments, Shared Savings, Gainsharing, Full or Partial Capitation, and other at-risk, value-based plans and payment models, this resistance to change will inevitably lessen.

However, individual markets, organizations, and even providers will transition at a varied pace that may differ considerably even in geographically close locations. Have no doubt--the change in risk-assumption will occur! The current system’s costs and relatively poor quality of care performance as compared to other economically developed countries is not sustainable. Therefore, those organizations that successfully engage their clinical providers in helping them to manage both clinical and financial risk will be at an advantage as they confront the adjustments and transitions ahead.

Related Insights