Are you ready for Accountable Care? Find out now.

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Technical agility for an uncertain future Uncertainty surrounding legislation, regulatory changes and payment reform bring up a critical question: which IT platform will meet our strategic goals for the future? The presentation will tell you what a “best-of-breed” really means, and why an interoperable IT strategy will help you effectively navigate the changing healthcare landscape and achieve improved revenue cycle performance.

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Executive Overview Healthcare organizations have been operating under a fee-for-service model for many years. As such, financial leaders have become well versed in implementing revenue cycle management systems and processes that primarily focus on the money that comes into an organization. Today, a new need is emerging. Healthcare reform and other system changes are moving the industry toward hybrid payment models such as bundled payments, shared savings, and capitation. To thrive in this new environment, financial leaders need to move toward profit cycle management – an emerging model that matches the revenues from new payment models with an improved understanding of the true costs to deliver patient care. The result: Positive financial performance – even in the face of declining payments – that can be reinvested in the mission to provide better care. The foundation of any business or household is profit, defined as revenue net of expenses (and applicable as such even to not-for-profit organizations). Regardless of whether you are start-up, a Fortune 500 company, or a family of four, you need to ensure that you are bringing in more money than you are spending. In many businesses, the formula to determine your “profitability” is fairly straightforward. In healthcare, however, the situation is significantly more complex, as existing and new payment models make it difficult to determine exactly how much revenue is going to come in the door. On the cost side, the move to accountable care and value-based payment has shifted the management of risk and cost onto the providers and delivery networks, yet most providers lack the tools that would provide a detailed understanding of the costs required to deliver quality care, especially when that care is delivered in multiple locations. A new model of software tools is required – representing the next generation of revenue cycle management tools and an emerging class of healthcare cost accounting tools. The end goal? A solution for profit cycle management that will help organizations generate a positive financial performance and can be reinvested in the mission to provide better care. This change will not happen overnight. Rather, it will be an evolution over the next five years, as integrated delivery networks update their revenue cycle solutions to accommodate the new payment models, and as they deploy new activity-based costing solutions.

The Need to Embrace Profit Cycle Management in Healthcare - Whitepaper

GE Healthcare - IT

When the Centers for Medicare and Medicaid (CMS) Innovation announced plans to select organizations for its Shared Savings Accountable Care Organization program in April 2011 via a proposed rule, reactions within the healthcare community were mixed. Some were excited by the prospect of a push for more coordinated and integrated care networks, while others criticized the specifics of the proposal, concerned that the level of provider risk and other provisions would make the model unsustainable over time. Subsequently, the Centers for Medicare and Medicaid Services (CMS) issued a Final Rule on Shared Savings Accountable Care Organizations (ACOs) that was much more positively received throughout the healthcare community. CMS then followed the Final Rule with an April 2012 announcement, adding 27 initial Share Savings ACOs to its original 32 Pioneer ACO group. With this backdrop in place, it’s clear that accountable care is more than the latest healthcare buzzword. Today, there is a clear change in the focus of healthcare providers, with an emphasis on shifting the focus of payment for hospitals, physicians, and other healthcare entities towards integrated care and a focus on value and quality of care rather than the volume of services provided.¹

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Whether referred to as integrated healthcare or accountable care, the current focus on new healthcare models is a reaction to long-standing concerns around quality, cost, and efficiency. Many of these issues stem from care delivery systems that have been: • Directed more at episodic treatment than prevention and early intervention • Fragmented rather than integrated and coordinated • Focused on patient eligibility and billing rather than patient engagement within and outside of the care setting • Customized to the idiosyncrasies of individual facilities rather than standardized across care sites • Rewarded more for volume than for quality and cost outcomes The resulting inefficiencies have made healthcare less effective, less safe, and more costly than can be tolerated, particularly against the backdrop of a challenging worldwide economy. The old dictum ‘if you provide healthcare, they will pay’ no longer applies. Public payers, private payers, and regulatory agencies are wielding both carrots and sticks to drive healthcare organizations toward greater coordination, demonstrable quality, and measurable cost control. The consensus on what ails our health systems, as well as the availability of new technologies, has led to the creation of new models of delivery, such accountable care organizations and integrated health organizations. By whatever name, these healthcare models are designed to promote accountability and improve outcomes for the health of a defined population.

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