Coker ValuePath™: Moving Successfully from Volume to Value

The healthcare industry is slowly moving from a volume-based business model, with primarily fee-for-service reimbursements, to a more value-based business model. Fee-for-value reimbursements are becoming more the norm, including bundled payments, shared savings programs, capitation payments, and other alternative payment models or APMs. This transition is particularly the case with CMS where the MACRA/MIPS payment system is rolling out, as are mandatory bundled payments for many hospitals performing total joint surgery. The providers making this move will need expert guidance and support from experienced advisors. Coker Group has created Coker ValuePath™ to provide just this type of advisory service. Coker ValuePath™ includes the following:
Coker ValuePath™ Assessment, which we consider the first step on the road from volume to value. This assessment couples an analysis of each client’s specific market dynamics with a review of their capabilities to operate successfully in a value-based reimbursement environment. We then issue a specific set of recommendations for how each client should proceed to ensure their success.

Coker ValuePath™ Alignment and Clinical Integration Services. While some say that form follows function, we believe in this case that the opposite is true. Quite simply, the traditional organizational structures inherent in the healthcare industry will no longer suffice to provide the kind of seamless, patient-centered care delivery across the continuum that consumers demand.

Coker has, therefore, developed significant knowledge and experience in helping providers, such as hospitals, healthcare systems, and employed or independent physician groups, create accountable care organizations (ACOs), clinically integrated networks (CINs), and patient-centered medical home networks (PCMHs).

Coker ValuePath™ Finance and Contracting Support.  In brief, value-based contracts will hold providers of healthcare services accountable for delivering high quality at low cost. There are many variations on this theme, however, and the providers of the future will need expert guidance in working through the nuanced details of each contract.

Coker understands the inner workings of value-based reimbursement (VBR) models and can help providers successfully negotiate bundled or capitated payment contracts, shared savings agreements, MIPS and alternative payment models (APMs), such as the Medicare Shared Savings Programs (MSSPs) and Bundled Payment for Care Improvement (BPCI) initiatives.

Coker ValuePath™ Care Process Design System. We understand at Coker that reorganization and structural changes can only go so far in truly transforming the healthcare system so that it can move from a volume to a value model.

Coker helps providers organize around VBRs and APMs and also can assist organizations in re-tooling front-line care processes so that they deliver high value more reliably, defined as quality per unit of cost. The Care Process Design System (CPDS) is a systematic approach to this clinical care transformation effort and incorporates such methodologies as Lean process mapping, time-driven activity-based cost accounting, and data-driven continuous process improvement.

Coker ValuePath™ Risk Management Services. Whether it’s managing risk under VBRs or taking on full risk as a provider-based health plan, Coker can help organizations who are facing more and more clinical and financial risk in their daily operations.

Our experts are knowledgeable about government and commercial risk contracting and mitigation of risk through the formation of provider-owned insurance captives. Further, for those clients who wish to assume full-risk under a value-based agreement, we can provide administrative claims management, member support, and actuarial support services

Coker ValuePath™ Technology Services. While Coker is not an IT vendor, we work closely with several of the leading suppliers of IT systems (population health analytics, health information exchanges, performance registries/databases, and electronic medical record systems) and can help organizations vet, install, and implement these systems.

We also understand that any healthcare technology must support and facilitate clinical workflows. Therefore, we strive to integrate IT systems within a care delivery system in a way that furthers the Triple Aim of Healthcare Delivery–Patient-Centered Care, Population Health Management, and Cost Reduction.

Coker ValuePath™ Marketing Services.  Coker understands that the consumer of value-based healthcare services will have a variety options and choices. We can help make sure that providers who are successfully driving value can demonstrate their accomplishments in the marketplace through traditional marketing and sales activities or via newer marketing channels such as direct contracting with large self-insured employers.

Whatever challenges your organization is facing as the industry moves inexorably forward toward a more value-based model of reimbursement and care delivery, Coker can help. For more detailed information on how we can do so, please contact sburnett@cokergroup.com.