So what do we mean when we say value based care? Value based initiatives transitions the care delivery focus from volume to value. This includes thinking about the entire patient experience among multiple care settings. Many hospitals are already experiencing bundled payments as it relates to joint replacements which is a form of value based care. Therefore, reducing costs and improving quality presents financial incentives while avoiding potential costly penalties. This actually shifts some of the financial accountability away from payers to the healthcare providers. Today, maybe 5% of your total revenue has some value based component in your contracts, but is projected to increase to nearly 40% within the next 5 years. The goal of the Department of Health and Human Services is to tie 50% of Medicare payments to a value-based payment model by 2018.

Providers will begin addressing new strategies that will include more data analytical tools to address population health management as well as improved patient billing techniques. Most hospitals today possess certified electronic health record technology which is a good starting point for revenue cycle analytics. More robust analytics can identify real time claims data combined with clinical data that can measure improved quality based on outcome results. Data will reveal expensive patient populations, which tend to have high readmission rates and frequent emergency room visits.

These analytics can also better identify root causes of denials, suggest resolutions and cause fewer write-offs. Whether you outsource your denied claims or work them internally, always attempt to identify root causes so that prevention measures can be implement.

As we begin to transition to value based contracts, new payment models will address access, quality of care and patient outcomes while driving greater value for our healthcare dollar.


Yvonne Focke, RN, BSN, MBA

Vice President, Clinical Operations

Praxis Healthcare Solutions, LLC