Taking on patient risk requires careful planning and the right leadership to carry it out. That’s why developing the correct structure is the second of five actions that allow your organization to take on medical risk.

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In a previous post, we outlined the five key actions needed to begin and successfully take on patient medical risk in a value-based reimbursement environment: Market Assessment; Strategic Structure; Population-Based Planning; Financial and Capacity Planning; and Value-Transformation Road map.

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Value-based models are becoming a normal part of the health care provider landscape. Several accountable care organizations (ACOs) are already taking on higher levels of patient medical risk, which means there are financial stakes in improving health and quality across the populations they serve.

Taking on risk is a complicated endeavor for most providers, but there are five key actions that several leading institutions are using for success.

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In a value-based reimbursement setting, your most important technology assets may be your data. That’s because data, coupled with the right analytics capabilities, can help you focus on the patients and the conditions that have the most potential for cost savings and care quality improvement. And isn’t savings and care improvement what this “value transformation journey” is all about?

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The premise of value-based contracting is that by changing incentives, health care organizations will help unhealthy people get healthy and healthy people stay that way. The change most value-based organizations are undertaking that stands to make the most difference in the health of patients is population health management (PHM).

Population health management is a proactive, patient-centric approach to health care that engages patients and physicians in prevention, wellness, care coordination, and care management with the goals of improving outcomes and reducing costs.
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As organizations move to value-based care the risk dynamics change from an operational to a population focus.  Population risk focuses on the value of care delivered to a defined population requiring innovative and transformational care delivery models to manage different risk segments.

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On the journey from volume to value, generating new capital is an important consideration. In the four articles posted so far in this series, everything discussed—patient access management, medical necessity management, and coding and documentation improvement—can help providers  access capital by reducing costs. In this post, we’ll discuss areas in which reimbursement is directly affected.
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In a previous post, I discussed the need to have clinical technology in place that allows for interoperability, that improves physician adoption, and that helps you streamline clinical and administrative processes. In this post, I’ll discuss technology that can further help your organization get its financial house in order as it journeys from volume to value.Miles Snowden, MD, MPH, CEBS Chief Medical Officer, OptumHealth

The implementation deadline for ICD-10 is less than a year away. Much has been written on this blog and in other forums about the potential of ICD-10 to hinder revenue cycle productivity and interrupt cash flow. Appropriate training and a good corps of consultants can go a long way to making you ICD-10 prepared. But technology also plays a vital role in your preparedness, especially for mitigating productivity lags and speeding up cash flow.
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In my most recent post about your journey from volume to value, we discussed how organizations can improve their technology and processes around patient access points and medical necessity. Today, my focus will be on clinical technology.
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In a previous blog post, I introduced my view of what organizations on the path toward accountable care need to do to progress on their journey. Today, and over my next few posts, I’ll share an in-depth look at how some organizations are strengthening current capabilities and developing new capabilities to help them navigate the journey from providing care to managing health.Miles Snowden, MD, MPH, CEBS Chief Medical Officer, OptumHealth

Two critical areas of improvement are patient access and medical necessity; advancements here can improve patient satisfaction, accepted claims, and cash flow. Ideally, medical necessity is a simple check during registration. In reality, comprehensive medical necessity management requires compliance in multiple other workflows, including point-of-care, health information management, and patient financial services.
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