Learning Hub

June 04, 2018

Making the Transition to Value-Based Care: Is Your Organization Ready?

As our industry shifts toward value-based care, insurers are incorporating more risk-based components into contracts with providers of all sizes. By 2019, an estimated 60% of medical practices' Medicare revenue will come from pay models that require providers to take downside risk, according to a new survey of AMGA members.

Taking on risk, however, doesn’t necessarily mean reward. According to the State of Population Healthy survey, one in five providers said they derive no revenue from risk-based contracts, while more than half earned less than 10%. It’s not that these providers had difficulty caring for at-risk patients -- it’s that they had difficulty “checking all the boxes” to prove they did so. Without the right tools and team in place, valuable details get lost and data goes unrecorded -- all at the provider’s expense. Preparation is key to success, since risk-based contracts force providers to remain one step ahead of their patients -- helping them make the right health care decisions before they end up in the emergency room. Unfortunately, only one in four physicians interviewed in a 2017 AMA study said they were prepared to meet statutory requirements.

The Right Way to Take on Risk

As the number of risk-based contracts increases in the coming years, healthcare organizations need to make sure they’re ready. If not, they may face financial penalties in the coming years.

First, make sure you have experts on your team who are committed to monitoring contracts and insurer relationships. With an in-depth knowledge of contract details and deadlines, these partners can help guide staff members toward achieving all contractual requirements regarding risk. Boncura’s team of experts help you prepare for taking on risk by putting systems in place to achieve bonuses. Our health navigators, insightful analytics, and information systems all work together to provide a full spectrum of patient care touch points to ensure you meet your benchmarks.

Second, invest in the right technology to track patient data accurately and easily. Once your staff is comfortable using the core features of your EHR platform, consider exploring additional options and integrations that might make contract compliance even easier. For example, Boncura’s Compass dashboard includes up-to-date data on quality incentives, generics utilization, and accounts receivable trends for quick reference.

Third, communication is key. Not only should your staff be on the same page when it comes to making risk management a priority; different software platforms should “talk to each other” without any delays or glitches. Interoperability can help providers meet risk-based contract requirements without draining resources, but most providers are not currently equipped. A recent study from the HFMA revealed that only 33% of hospital leaders reported their facility was highly capable of interoperability, but 98% of study participants admitted that interoperability was ‘highly’ or ‘extremely’ important in the move to value-based payment in the next three years. This suggests that providers acknowledge the importance of interoperability -- they just don’t have the resources to achieve it.

Outside Resources for Risk-Based Contracts

 Expanding your organization’s administrative staff, testing and procuring the right technology, and streamlining all of your systems can quickly drive an organization off schedule or over budget -- which is why many healthcare providers turn to companies like Boncura for help. Our client, Dr. Soujanya Pulluru, Medical Director with DuPage Medical Group, has said, “With more payers looking to incorporate risk into their contracts, our team feels prepared to make the transition to value-based care thanks to Boncura.” Designed by physicians and for physicians, our services help ACOs, physician groups, and hospitals see the upside of risk-based contracts. From our integrated IT solutions to our experienced account managers, we help providers of all types and sizes see the positive results of taking on risk-based contracts.

Analytics and reporting: Stay one step ahead of your risk-based contracts with robust analytics and reporting tools. With the right tools -- and the right data analysts -- you can quickly identify at-risk populations and monitor their health. Predictive and prescriptive analytics will help your organization manage preventive care services and readmissions, as well as provide real-time support for physicians making decisions. Boncura’s analytics dashboard allows providers to view the information they need in one simple view, and our team of data specialists provide the support you need to make sound business decisions based on facts.

Information technology: When it comes to managing risk, the more data you have the better -- but it’s impossible to make sense of all the details without a single platform to consolidate and analyze information. Boncura’s expertise in the Epic platform has helped dozens of providers streamline business operations and save time. We teach clients how to make the most of Epic’s advanced features, and recommend extensions and add-on applications that can help them integrate various IT systems. Boncura’s IT strategists are here to help you reduce the technological burden of risk-based contracts.

Interested in learning more ways you can ready your organization for more risk-based contracts? Contact us.

About Boncura Health Solutions
Since 2011, Boncura Health Solutions has remained a dynamic organization aimed at improving patient outcomes, efficiently managing at-risk populations to reduce unnecessary healthcare costs, delivering services in a cost-effective manner, and providing unique and convenient ways for patients, providers, and clients to access key support services. Founded by physicians, Boncura’s expertise allows hospitals and health systems, independent physician groups, and accountable care organizations to provide value-based care through efficient and intelligent administrative and clinical services. Today, Boncura serves more than 7,000 physician providers and partners, managing upwards of 450,000 lives, and processing more than eight million claims annually.

 

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