How do you build the business case to overcome the barriers and elicit support for changes in how health care is delivered and paid for? Three groups — the Network for Regional Healthcare Improvement, Center for Healthcare Quality and Payment Reform, and Robert Wood Johnson Foundation — have published a guide to help.
Ten steps for making the case are presented:
- Define the planned change and expected results
- Estimate how the type and volume of services will change
- Determine how payments/revenues will change
- Determine how service costs will change
- Calculate the changes in provider operating margins
- Identify the changes in payment needed to maintain positive financial margins for providers
- Determine if a business case exists for both providers and purchasers
- Refine the changes to improve the business case
- Analyze the potential impact of deviations from the planned care and outcomes
- Design a payment model that pays adequately, assures wanted outcomes, and controls risk and variation
Details and examples are provided for each step. Data on billing/claims, clinical health records/registries analysis, service costs, and patient-reported outcomes will be needed for the analysis.
Source: Miller HD. Making the business case for payment and delivery reform. Network for Regional Healthcare Improvement, Feb. 24, 2014. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf411117
Posted by AHA Resource Center (312) 422-2050, rc@aha.org
Filed under: Accountable care organizations, Best practices, Financial management, Insurance, Integrated delivery, Posted by Diana Culbertson | Tagged: bundled payments, coordinated care, populaltion health |
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