How to Start the Value-Based Care Conversation with Clinical Leadership

Value-based payments are changing the healthcare financial landscape. In fact, by 2020, value-based reimbursement is projected to represent 83% of your revenue, up from just 14% in 2010. There’s no denying that clinical operations will become crucial to your hospital’s bottom line. Now more than ever, it’s important to engage with clinical leaders, arming them with the data, tools, and processes they need to make sure you’re adequately reimbursed for the care you provide.

Here are three ways to increase engagement with your clinical teams: 

1. Data Benchmarking 

One of the first steps in integrating clinical operations into the financial mix is gaining a comprehensive picture of your documentation and coding performance. The best way to quickly spot your biggest opportunities to improve revenue capture is through data benchmarking. With a holistic view of your financial health—in comparison to your peers—you can identify unspecified code usage, opportunities for greater specificity under ICD-10, and any physician training initiatives that may be needed to help fill documentation gaps.

2. Physician Training 

Your physicians can be reluctant to change. In the transition to a value-based care world, however, change is imperative. With analytics, you can engage physicians around data they find meaningful and actionable. You can then create physician champions and drive appropriate documentation specificity by offering detailed analytics and benchmarking data around the diagnoses that matter to them. 

3. Ongoing Monitoring 

As healthcare evolves, it’s important to develop a plan and process for ongoing monitoring of documentation, coding, and compliance. With a holistic view of your data, you gain complete visibility into how your clinical performance is affecting your bottom line, allowing you to reduce denials, measure the impact of ICD-10, and mitigate audit risk today and for reimbursement changes yet to come.

Approaching value-based care is an enterprise-wide responsibility. From the C-suite to physicians, everyone has a role in ensuring not that you find more revenue, but that you find the right revenue. A complete view of the revenue cycle can help you evolve with reimbursement changes without negatively impacting your bottom line.

Learn more about Revenue Integrity to help your clinical and financial leadership get the data they need to start the value-based care conversation. 

MedeAnalytics

MedeAnalytics is a leader in healthcare analytics, providing innovative solutions that enable measurable impact for healthcare payers and providers. With the most advanced data orchestration in healthcare, payers and providers count on us to deliver actionable insights that improve financial, operational, and clinical outcomes. To date, we’ve helped uncover millions of dollars in savings annually.

Leave a Comment





Get our take on industry trends

Data and Social Determinants of Health

December 19, 2019

By Scott Hampel – I think a lot–and I’m not the only one–about how we can improve the ways we pull information from data. Data on its own is inert: just waiting to be understood and then used. And that’s a major challenge for many organizations. Data is often trapped in different applications with no easy or convenient way to extract it.

Read on...

Why Social Determinants Need Analytics for Success

December 10, 2019

Many challenges face healthcare’s underserved. There are issues with food, housing, reliable transportation, steady employment and more. Each contributes to and is one element of social determinants of health (SDH). In communities around the world, public and private organizations are taking steps to address SDH-related issues and challenges that negatively impact healthcare.

Read on...

Healthcare Organizations Recognize Importance of AI for Reporting

November 21, 2019

Healthcare providers continue to recognize the value of using AI in reporting operations throughout the organization. AI has many strengths when applied to the healthcare industry:

Read on...

Why It’s Time for Healthcare to Move Toward AI Reporting

November 5, 2019

Business intelligence (BI) was a dramatic and significant step forward in healthcare industry reporting and a natural transition to artificial intelligence (AI) enabled real-time insights.

Read on...