Coker ValuePath™: Successfully Navigate the Path 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 payment models, shared savings programs, capitation payments, and other alternative payment models or APMs. This transition is particularly the case with CMS where the Medicare Access and CHIP Reauthorization Act (MACRA)/Merit Based Incentive Payment System (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 Payments 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 (TDABC), 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 us.
Coker ValuePath™ Services
Coker ValuePath™ Assessment Services
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.
Coker ValuePath™ Alignment and Clinical Integration Services
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 ValuePath™ Finance and Contracting Support
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.
Coker ValuePath™ Care Process Design System
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 (TDABC)
- 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.
Coker ValuePath™ Risk Management Services
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.
Coker ValuePath™ Technology Services
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.
Coker ValuePath™ Marketing Services
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 us here.