The Four Things You Can’t Take Risk Without
Value-based payment models like BPCI Advanced, CJR, and commercial bundles are driving an estimated $2 trillion shift in risk from payers onto providers. More than $300 billion in healthcare spend is avoidable, due to waste and inefficiency that stems from unwarranted variation in care. A root cause of this variation is non-personalized care delivery compounded by limited visibility into the progress of a patient’s care journey outside the doctor’s office.
In the fee-for-service model, there is little incentive or ability for providers to closely track and manage the care of patients across their entire journey through the healthcare system. However, if you’re taking on risk, this just doesn’t work.
The foundation for success in risk-based arrangements lies in the quality and recency of your data such that it allows you to assess risk and predict performance in real-time. The right data and analytics will enable healthcare organizations to:
1. Understand variations in care workflows at the patient, physician, and facility levels, enabling clinicians and care delivery partners to understand the drivers of individual performance and make improvements
2. Make apples-to-apples comparisons, aligning stakeholders by creating a common yardstick from which to benchmark costs, key results, and measure success
3. Risk stratify every patient as they enter the system, enabling care teams to prescribe precise and personalized care journeys
4. Monitor and coordinate care in (near) real time, identifying and addressing issues before or as they occur
Once you’ve got the right analytics in place, the next step is real-time care management. As success in care delivery shifts to managing patients across several providers and sites of care over an extended period of time, the importance of effective communication and collaboration grows. Good collaboration begins with a shared understanding of goals, roles, and expectations. Visibility and transparency help individuals to act in a timely and appropriate way.
As obvious as it might sound, what’s often missing today is a simple start-to-finish, step-by-step roadmap to set expectations and enable collaboration. Successful organizations are investing in technology that facilitates setting clear, precise and personalized plans, protocols and task lists. Additionally, digital tools to connect patients with their care team are being deployed to monitor progress across these planned journeys. Automating the collection of data and linking interventions to outcomes then creates the means to provide meaningful and relevant feedback to drive improvement through enhanced collaboration.