In the changing healthcare industry, flexibility and adaptability are critical qualities for systems to succeed. Those systems that maintain a nimble approach will have a better chance at capturing revenue, making efficient transitions, and successfully adapting to the changing landscape of the current administration. A nimble approach to patient care incorporates several key strategies.
Using Larger Systems for Healthcare
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Robert Laszewski, president of Health Policy and Strategy Associates in Washington, D.C., addressed the changing healthcare model at a 2016 Large Urology Group Practice Association (LUGPA) Annual Meeting. He noted that consolidation will continue throughout the healthcare systems as the trend toward hospital mergers increases. He called participation in a large practice group “an imperative.”
Dr. Victor J. Dzau, president and CEO of Duke University Health System, believes health centers need to pursue efficiencies through innovation. He recommended that providers “create systems, not centers. Be an integrated delivery system.” Nimble operations and open collaboration is important, particularly for academic centers. Although research and education healthcare centers are more cost than revenue, Dzau noted that they can improve efficiency through collaboration.
Ascension CEO Dr. Anthony Tersigni echoed these sentiments. The Ascension healthcare system includes 2,500 sites of care. Tersigni emphasized that these sites of care “put patients in the right setting for the right care at the right time.” Using integrated systems of care is a core component of establishing nimble healthcare systems that can deliver what patients need quickly and efficiently.
Laszewski summed up the situation with the following prediction: “Twenty years from now, healthcare will still be the largest industry in the U.S. Those physicians who adapt will be successful, will continue to serve patients, and do it in a way that lets them thrive.”
Transitioning Efficiently to Value-Based Care
Tersigni likened the transition from fee-for-service to fee-for-value care to “changing a flat tire on a car while it’s moving …. No one has figured out yet how to do it, but you’re going to have to figure it out.”
Transitioning to a value-based system is a challenge that all healthcare systems are facing. Remaining nimble is essential for those that hope to succeed at this challenge.
Value-based programs are patient-centered, with provider reimbursement that rewards the quality of care rather than the quantity of treatments. This arrangement is designed to shift the burden of care to the provider rather than the patient by encouraging physicians to seek solutions that provide the best outcome possible regardless of the number of visits or services involved.
The gradual implementation of value-based programs will continue through 2019. A nimble approach to healthcare practices is important for providers to succeed with the rapid changes taking place over the coming years.
Keeping Costs Low While Embracing Innovation
Innovation is important in the healthcare industry, but adopting new technologies often comes with stumbling blocks in the forms of both time and money. Nimble health systems are well-positioned to innovative efficiently without depleting their budgets. In an article for Forbes, author Dave Chase defined “nimble medicine” as “a rapidly building wave of innovative new care and payment models.”
Chase expected such an approach to help healthcare make the same transition in access and affordability that the food industry has made over the last century. He noted that at the turn of the 20th century, food consumed more than 40 percent of household income, where it has now decreased to only 8 percent. A nimble healthcare system, he contended, may see similar breakthroughs by adopting low-cost technology solutions to better manage patient care.
Leveraging Integral Opportunities to Maintain Revenue
A steady stream of revenue is essential for any healthcare system to continue operating effectively. Healthcare systems that remain nimble are poised to move, adapt, and proactively capture revenues that may otherwise be lost. Rather than becoming mired in a concrete set of policies, a nimble system can remain vigilant for opportunities to adjust as needed to recover as much revenue as possible, even in a challenging environment.
According to a NextGen Healthcare survey, 47 percent of participating provider organizations neglect to resubmit denied claims, which effectively forfeits the valuable opportunity to collect earned revenue. Implementing more effective denials management comes in many flexible forms, including the following:
- Implementing more efficient claims technology to prevent denials in the first round
- Evaluating patients for Medicaid or Medicare eligibility to shift them onto insurance plans with adequate coverage
- Analyzing denials for avoidable patterns that systems can manage proactively in the future
Ongoing evaluations with nimble adjustments are key to maintaining a steady revenue stream that brings in as much funding as possible. Healthcare IT News recommended cyclical management with the goal of 90 to 95 percent net collection and a 90 percent clean claim rate.
Building the Correct Foundation for an Uncertain Future
The state of the healthcare industry is often complex and confusing, which can leave patients and providers alike in a place of uncertainty. A nimble healthcare system can maintain flexibility in the face of change. Leaders may need to adjust quickly to changing policy from a new administration. Establishing the correct foundation early will make adapting to changes somewhat smoother.
Communication is significant. Implementing strong lines of communication can facilitate more efficient transitions within an organization. Taking the time to identify obstacles in these communication streams early can ensure a smoother flow of information while the healthcare system is actively transitioning to new strategies or business models. Healthcare systems can also adopt a safe and nimble approach to change by incorporating exit ramps into innovative new strategies. These avenues promote possibilities to abandon or adjust as needed with minimal loss of time or revenue.
You can play a role in keeping healthcare systems nimble and adaptable in the coming years. With a master’s in healthcare administration online, you’ll receive the foundation you need to help providers build their own stable base for a successful future. Consider pursuing theUniversity of Southern California Executive Master of Health Administration online program at the USC Sol Price School of Public Policy to take your healthcare career to a new level. Join professionals from around the world who are intent on making positive contributions to better the state of healthcare.
Sources:
http://www.healthcareitnews.com/blog/keeping-revenue-cycle-nimble
https://www.advantageperformance.com/health-care-organizations-2017/