Transformation from Volume to Value

The industry is responding very slowly to the move to Value-Based Care. Instead of taking steps to move forward with a new model of care delivery and creative payment models, everyone is waiting for the next CMS edict or decision from Congress.

The industry should be examining the inefficiencies in the current system, determining how each organization needs to create a new model to analyze information, create continuous process improvement models, gather population health information, and better manage the care of its patient population.

This change will take careful planning and thoughtful execution. Payers need to begin meeting with their provider networks to build new collaborative models. Providers should reach out to payers to determine the best course of care payment contracting. Together they need to establish boundaries, connections, and information integration to create value for patients and to contain costs.

Here’s what I feel are the next steps from volume to value-based care:

  • Each organization needs to be engaged in a readiness assessment, current state analysis, and information systems capability matrix.
  • Develop operational strategies and address data integration, cost benefit drivers, and workflow integration.
  • Create a Value-Based information architecture, addressing medical and administrative expense, appropriate revenue models, care quality, analytics, technology efficiency, process improvement initiatives, and quality focus.
  • Define payer and provider collaboration to establish a win-win scenario and environment.

The ultimate objective is to foster a Continuous Healing Relationship, where patients and providers work together to create more efficient and effective care models.

For more information, watch my webcast presentation below:

Dr. Bill Bysinger

Bill Bysinger, Ph.D., MBA
HCIM Sr. Strategic Adviser

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.