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The Role of Finance in Managing Variation in Clinical Cost and Quality
As a response to mounting healthcare costs and concerns about the quality of the care those dollars are buying, payers increasingly are exploring ways to bend the cost curve and improve quality to yield greater value. For healthcare delivery organizations in this environment, strategic alignment with clinicians has never been more important.
Both public and private payers have committed to make the transition to value. In early 2015, the Centers for Medicare & Medicaid Services (CMS) famously announced its intent to increase payments through value-based payment models (e.g., bundled payments and risk-sharing agreements) from 20 percent in 2014 to 50 percent in 2018. A short time later, the private-sector Health Care Transformation Task Force answered with a commitment that, by 2020, its members would be operating under 75 percent value-based payment contracts. The task force — a 28-member alliance of leading providers, payers, employers, and other partners — is committed to meeting its goal by improving the accountable care organization (ACO) model, developing a common framework for bundled pricing, and improving care for high-cost patients.
With the development of value-based care models clearly underway, hospitals, health systems, and other provider organizations face an ongoing question of how to evolve to meet the challenge. The answer, in part, is that these organizations should reconsider the roles and interfaces among financial, clinical, and administrative leadership to effectively manage variation in clinical cost and quality.Read More
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