Navigating the Journey from Providing Care to Managing Health

With all the emphasis that payers and providers are placing on transitioning the health care system from incentivizing volume to incentivizing value, the reality is, with all the progress made, health care remains entrenched in fee-for-service.

The transition to fee-for-value is certainly happening. The Centers for Medicare and Medicaid Services’ (CMS) accountable care organization (ACO) efforts are gaining a lot of attention, and commercial payers are spending billions of dollars converting to risk-based contracts.1 But any industry that is responsible for nearly 20 percent of the nation’s gross domestic product will take some time to transform.2 It’s going to be a long journey.

And the journey is going to be different for each organization. Local markets, regional biases, municipal and state regulations, institutional structure and corporate cultures all contribute to the uniqueness of every provider’s situation. A generic map for the journey from volume to value doesn’t exist; every organization making this journey will need to create its own path.

But there are stages of the journey through which every organization will trek as it moves from volume to value. This paper will highlight those stages:

  • Optimizing financial efficiency by innovating around key areas of the revenue cycle
  • Designing a roadmap that plots how organizations will transition from a delivery model of volume-based care to one that is value-based
  • Investing in capabilities that will help sustain the organization in the shift from fee-for-service to fee-for-value

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