Do You Have the Guts To Be a Healthcare Innovator?
If you're in charge of running a hospital or health system, managing the passive risk of payment reform is a given. To push your organization ahead, you'll need to take on the bigger risk that comes from being truly innovative.
For many hospital and health system chief executives, the embodiment of taking risk as it pertains to their organizations means talking about the new payment paradigm. This is the one under which government and commercial payers work with health systems to derive better value from their purchase of healthcare services. In other words, value-based care.
As opposed to fee-for-service payment, value-based payment puts the hospital, health system, or physician "at risk" for lower payment depending on a variety of metrics that attempt to measure the value of the patient outcome.
This is a very inexact science at this time, and that's one reason it's taking so long to figure out ways to incorporate risk into payment methodologies for commercial and government payers alike. Incidentally, despite all the fretting about risk-based payment, fee-for-service is still the dominant payment mechanism for the vast majority of hospitals and health systems.
Some regions are seeing the evolution in payment models more quickly than others, but the key is that it's changing very slowly. Of course any health system that incorporates a health plan into its business entities is already familiar with the gaps in information and analytical tools that would truly allow them to place a value on a health provider's services from a quality of care or efficiency standpoint.