Value-Based Care and Reimbursement

  • Max Reiboldt, CPA

    Max Reiboldt, CPA



Navigating the Transition: Coker’s Value-Based Healthcare Solutions

Moving from volume-based to value-based payments in healthcare is a complex challenge that requires careful planning by leaders in various organizations. Whether you’re a large healthcare system considering at-risk population health management, a hospital navigating bundled payment models, or a physician practice adapting to MACRA/MIPS, critical decisions must be made.

Challenges and Key Decisions

Transitioning to value-based care involves new cross-enterprise capabilities in clinical, administrative, and financial aspects. Healthcare leaders need to address key issues such as:

Care Delivery Performance:
  • Evaluating and improving the quality and efficiency of care delivery.
Post-Acute Care Strategy:
  • Planning for effective post-acute care to enhance patient outcomes.
Large Patient Populations:
  • Managing the health of diverse patient populations efficiently.
Multiple Contracts:
  • Navigating and fulfilling obligations under various payer contracts.
Physician Distributions:
  • Ensuring fair and appropriate distribution of responsibilities among physicians.
Effective Usage of Technology:
  • Leveraging technology for enhanced healthcare delivery and management.
Regulatory Compliance:
  • Adhering to regulations and compliance requirements in the evolving healthcare landscape.

Coker’s Approach

At Coker, we provide a suite of advisory and technology-related services to facilitate a smooth transition. Our Coker ValuePath™ services focus on operationalizing clinical and administrative processes, including:

  • Clinical Care: Enhancing clinical processes for improved patient outcomes.
  • Network Integration: Facilitating seamless integration of healthcare networks.
  • Revenue Enhancement: Identifying opportunities to enhance revenue streams.
  • Risk Stratification:Implementing strategies to effectively stratify patient risk.
  • Beneficiary Tracking: Monitoring and tracking patient progress and outcomes.
  • Three Pillars of Success:

    Our perspective revolves around three pillars:

    • 1. Alignment Models: Developing strategic alignments with partners for shared success.
    • 2. Care Process Design System: Designing and optimizing clinical workflows for efficiency.
    • 3. Financial Strategy: Formulating financial strategies to navigate changing regulations and contracts.

    Value-Driven Approach:

    Value, defined as quality-per-unit-of-cost, is at the core of our three pillars. We utilize an array of services within these pillars to help organizations achieve desired outcomes. From network development and financial forecasting to clinical workflow improvements, our goal is to assist organizations in successfully embracing value-based initiatives.

Questions? Ask an expert!

    Contact us today for more information about our healthcare consulting services and learn how we can help your organization.

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