Balancing effective risk management with quality patient care was never easy. In today’s quickly evolving industry it has never been harder. The business of healthcare is no place for the faint of heart or the ill-equipped.
The high costs and inefficiencies of healthcare delivery in the United States have bedeviled the industry for decades as have attempts to address the problem. Experienced financial managers are acquainted with disruption to their business models. Now, the drive toward value-based healthcare is the benchmark throughout the industry.
Passage of the Affordable Care Act gives this evolutionary drive a kick in the pants. New Medicare Access and CHIP Reauthorization Act provisions drive old but seemingly new business models and incorporate value-based metrics aiming to weave quality care into historically cost-focused programs for a variety of member populations, rewarding value over volume. As with anything changing so fast, there are growing pains.
Whether the current push for value-based accounting succeeds remains a matter of lively debate. In the meantime, financial managers and CFOs must deal with the day-to-day reality of managing costs and meeting the “value threshold” for payment mandated by this shift toward quality.
We talked with three experienced healthcare financial professionals to get a glimpse of the challenges they face, some of the tools they use, and their assessment of the industry today.
You Get What You Pay For: (or what you get depends on who pays for it)
Fee-for-service incentivizes, arguably, the wrong mindset for providing care. It’s an “assembly line” mentality, says Rene Olavarrieta, a financial manager of Health Choice Network.
“I feel the move to value-based care over fee-for-service is long overdue. By tying quality to reimbursements,” says Olavarrieta, “payers are driving providers to ensure patients are provided care that achieves appropriate outcomes and