2020 Outlook: Value-based Care & Reimbursement
MARKETING & REIMBURSEMENT
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Maria Todd is frequently engaged as a consultant to prepare physicians, hospitals and ambulatory surgery facilities for value-based care marketing and reimbursement strategies.
Over the past decade, she’s led disruptors on both the payer and provider side ready to make the leap from simplistic fee-for-service reimbursement to value-based care marketing and contracting strategies. Here’s a high-level summary what she’s learned along the way.
What are the barriers to adoption?
Maria Todd:
1. Not knowing one’s costs to provide care in the fee for service or shared risk arrangement.
2. It’s outside providers’ comfort zones. Lack of leadership support and capacity. More training needed; not enough time in the day to prioritize this.
3. Lack of training and experience with shared risk contract analysis and negotiations – what to look for; how to decide.
4. Lack of payer readiness to process bundled claims.
5. Inappropriate provider compensation and incentives in draft agreements.
6. Provider inexperience and lack of know how to approach payers with a pilot program to test the concept, present brand strengths, and win alternative payment contract opportunities. Likewise, provider contracting representatives are yet unprepared or untrained to discuss shared risk and value-based care strategies and don’t yet have authority from the C-Suite at their respective health plans.
What are the greatest advantages to adoption?
Maria Todd:
- Fewer medical errors, complications, readmissions and payer or consumer costs.
- Increased patient satisfaction
- Increased provider and physician satisfaction
- Lower costs to collect for services rendered, accelerated payment
- Fewer denied claims and appeals
- Easier satisfaction of price transparency publication and surprise bill regulations
- Higher margins with the right shared risk contract terms and conditions
- Greater profitability and more accurate and consistent reimbursement
Do you have questions about value-based care program design or shared-risk contracting, pricing, or marketing or branding strategies?
Schedule an appointment to discuss your concerns. Request a time for a courtesy chat with this form.
AskMariaTodd™
…for more information about what’s been mentioned in this article or something else you’d like to learn more about
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