In the culinary world, professional chefs are masters with their knives, using swift, careful and precise techniques to create uniform slices of carrots, onions, and even meat. In healthcare today, slicing and dicing data can be done in many ways – ways that are meaningful to your organization – with powerful analytics as your master tool.
When it comes to working with payers and negotiating new risk-based and value-based care contracts, drilling deep down into claims and looking at your data across care delivery points, departments and facilities is critically important.
That’s in part because payers are now influencing clinical and revenue cycle decisions in a variety of new ways. Understanding how to navigate this new environment requires insight into how the landscape with payers is shifting, something we like to call Payer 101.
- Payers to increase reimbursement on cost and quality data and outcomes. Providers need to understand their cost of providing services, their patient population stratified by utilization, condition, and risk, and know what quality metrics are most applicable to their organization.
- Healthcare organizations need to track across broad categories of quality. As quality measurement grows, organizations will need to measure and report many more metrics across broad categories of quality, including structure, process, outcome, and patient experience. They’ll need to track against benchmarks, which may impact their clinical approach, and they’ll need data from payers to understand and assess baseline numbers, ongoing utilization, and cost and quality metrics.
- Payers and organizations need to collaborate more. Care coordination is a fundamental part of bundled payments and alternative payment models (APMs) – that means closer integration with hospitals, specialists and other care providers, payers and others who are committed to reimagining care delivery.
Bottom line, when it comes to working with payers: providers must know their value propositions, and they must be supported by facts and information that demonstrate they’re providing the right services and care, in the right facility, with the right utilization and cost. That’s only possible if you can gather deep, actionable insight from your reports and data. Whether you’re in the kitchen or in the office, it’s important to have the right tools and skills at your disposable.
Some additional resources to help on this topic:
- White Paper: Using Business Intelligence to Accelerate Your Revenue Cycle
- On-Demand Webinar: Dancing with the Devil: Negotiating with Managed Care Companies