The first step on the road from volume to value should be an assessment of an organization’s unique market dynamics related to the volume-to-value shift and its capabilities to operate successfully in a value-based business model. Coker approaches these Coker ValuePath™ Assessments systematically and gives the client both an overview of their specific situation and a set of clear recommendations for their next steps to take in moving from volume to value.
The Coker ValuePath™ Assessment is a short-term but complete engagement that provides each organization with a customized road map for proceeding. It will answer specific questions, such as how to respond to the MACRA legislation and the roll out of MIPS, how to become a qualified participant in a basic or advanced APM, how to profit under a bundled payment agreement, and when to enter into a narrow network agreement.
Traditional structures such as a hospital’s organized medical staff, hospital employed physician networks, single or multi-specialty physician practices, and payer-driven preferred provider organizations are no longer adequate to house clinically integrated providers. Clinical integration involves constant measurement of outcomes, both quality and cost, and the sharing of this data to drive improved value for the healthcare consumer. Clinical integration also includes coordination of care between disparate providers to deliver to the consumer a seamless, high-quality, cost-efficient care experience.
At Coker Group, our significant experience in developing organizational structures, such as Clinically Integrated Networks (CINs) or Accountable Care Organizations (ACOs), will serve both to house and facilitate the critical functions of clinically integrated provider organizations. Though not attorneys, we are well-acquainted with the legal and regulatory requirements for CINs to be able to market and contract jointly for services.
If you are considering creating a clinically integrated organization de novo or thinking about transforming an established organization, such as an Independent Physician Association (IPA) or a Physician Hospital Organization (PHO), into a clinically integrated entity, we can help.
Coker is familiar with the various types of value-based contracts that are becoming more the norm throughout the healthcare industry.
Whether you are presented with a bundled payment contract, a shared savings agreement, or even considering accepting full risk under a capitation model, Coker can help assess and determine your capabilities to succeed in a value-based reimbursement environment.
We work with hospitals and healthcare systems of all sizes, and we also work with many employed or independent physician groups. We stay abreast of the major trends in the industry, and our consultants have an in-depth knowledge of both the provider and payer side of contracting.
Our experience in the contracting area is extensive, and our track record of helping many organizations maneuver successfully through a confusing and high-risk landscape is second to none.
At Coker Group, we do not believe that our work is over once we’ve helped re-organize providers into clinically integrated organizations such as ACOs. In fact, we think that’s when the real challenges begin of re-tooling the delivery system to provide higher value, defined as quality per unit of cost, at the bedside or exam room level.
This re-tooling effort, which we call Coker’s Care Process Design System (CPDS), uses the latest in change management and process improvement tools and methodologies to include:
- Multi-disciplinary teams
- Lean process mapping
- Time-driven activity-based cost accounting
- True outcome measures
- Data-driven process improvement
- Continuous learning through the sharing of successes
While the transition of the delivery system from a volume-to-value model can be daunting, our experts can help you approach this transformation in a systematic fashion that utilizes proven techniques. In the end, your organization will benefit by creating an environment that supports and engages clinical innovation, well positions you to operate in a value-based purchasing environment, and most of all creates higher value for the patients you serve.
Moving from a volume- to a value-based business model can be a formidable prospect, one that many providers and healthcare administrators consider too risky.
At Coker Group, we understand this reticence; however, we also believe that value-based reimbursements and risk-based population health management contracts are the waves of the future. Hospital or physician groups who ignore this sea change in the healthcare economy do so at their peril.
The question, then, becomes how to manage the risk effectively in this change process and mitigate the potential downsides of moving from the current predominantly fee-for-service (FFS) reimbursement model to a primarily fee-for-value (FFV) payment system.
We believe that several crucial capabilities can help providers manage this risk effectively, which include:
- Timing the switch carefully from one business model to the next. No two organizations are the same regarding their particular market environment. Some will need to make changes quickly to keep pace with new reimbursement models. Others have more time and can plan more deliberately.
- Redesigning the structure and function of the care delivery system. The current model, which works quite effectively for most in a FFS system, simply won’t reliably provide the high-quality and cost efficiency demanded by an FFV system.
- Understanding and reducing costs. Providers can no longer use notoriously inaccurate proxies for cost, such as charge-to-cost ratios. Instead, they will need to know how to use more sophisticated cost accounting systems and learn how to project costs going forward to reduce expenditures in an organization systematically, where delivering high quality at low cost will be the key to success.
- Accessing global reinsurance markets. Even the best of providers are prone to unexpected risks. These outlier costs, however, can be mitigated through reinsurance. At Coker, we believe this protection can be achieved most effectively through the formation of provider-owned insurance captives, such as those that have been used in the past to manage liability risk for providers.
Value-based healthcare delivery requires new and innovative types of technology, some of which can be quite expensive. Therefore, those wishing to make this move must have expert advisors, such as those at Coker Group, who can steer them effectively and efficiently through the maze of options available today in healthcare information technology. Careful sequencing and staging of technology implementation over time can save millions of dollars and ensure that well-designed workflows are supported by but not driven by IT systems
Coker’s ValuePath™ Technology Services also can help with critical support and advisory services in the areas of data governance, MACRA/MIPS performance data reporting, solution search and selection, clinical informatics, process management automation, predictive analytics, population health analytics, and development of an integrated reporting strategy. Our goal is to provide value-based care providers with actionable information that can be used to enhance individual patient care delivery, optimize population health, capture all available revenues, and maximize cost efficiency.
Marketing and sales of value-based healthcare services will be different from marketing volume-based or fee-for-service healthcare. First, demonstrating value (high quality and low costs) will be key and data will be needed to back up claims of high-value care delivery. Second, capturing market share of value-based reimbursements or population health contracts will be the goal as opposed to capturing referrals or individual patient visits. Finally, a marketing strategy for any specific healthcare organization must be customized to meet the unique demands of their individual market.
Coker can assist in the development and implementation of a well-crafted, value-based marketing plan that helps each of our clients become their market’s leader in the delivery of high-value care services.
Coker has significant knowledge and experience in the all of the above areas. To learn more, please contact firstname.lastname@example.org.