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Uncertain Reimbursement Environment Means Providers Must be Nimble

Rene Letourneau, for HealthLeaders Media, August 19, 2013

In response to the uncertain—and yet inevitable—changes that are coming their way thanks to healthcare reform, CHE Trinity Health has made some modifications to its conventional business model, Barnett says.

"For the first time, we are employing actuaries, which is different than the traditional way of thinking in healthcare," she says. "We have to model and predict what the future holds so we can determine how it will affect us, so we can plan and adapt to implement the best response."

In addition to the use of actuaries to analyze financial risk, CHE Trinity Health is also considering passing some of the risk created by new payment models on to its physicians.

"We are also exploring clinically integrated models where the physicians are tied to the outcomes, and they share some of that risk," Barnett says. "Historically, we have been focused on treating patients after they get sick, but now we are focused on trying to prevent them from getting sick. Payments are based on quality metrics, reimbursements are changing, and we have to change our model and focus on population health management."

Although guiding the health system through these substantial financial changes is no easy task, Carter knows he and his colleagues don't have much choice because the industry is evolving rapidly.

"We are positioning ourselves well in an ever-changing environment. If you keep looking out through the periscope outward, it allows you to begin navigating the rough waters," Carter says.

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1 comments on "Uncertain Reimbursement Environment Means Providers Must be Nimble"


David Morledge (8/19/2013 at 3:54 PM)
The greatest concern I have for all these shared risk models is that in addition to morbidity, there needs to be a cost for mortality. There is very little actual cost to healthcare systems for morality, and in a purely financially driven model, it would often be the best outcome. For instance, if a hospital has a statistically significant worse mortality rate for out-of-hospital cardiac arrest, there needs be a clear fiscal consequence.