Steven lash San Diego explain how Value-based care models goal is to make healthcare providers accountable for the services they provide to patients, but they are designed to shift financial accountability to healthcare organizations from payors.

1. Healthcare Revenue Cycle and the
Impact of Value-Based Care by
Steven Lash San Diego

2. The change from fee-for-service to value-based care
payments impacts revenue cycle management.
• Value-based care models goal is to make healthcare providers
accountable for the services they provide to patients, but they
are designed to shift financial accountability to healthcare
organizations from payors. Many providers are confused on
how to align their revenue cycle management strategies with
value-based reimbursement.
• In a June 2016 survey conducted by Health Catalyst, less than
one-quarter of hospitals reported that they are on track to
achieve the goal set by the Department of Health and Human
Services (HHS) to tie 50 percent of Medicare payments to a
value-based payment model by 2018.

3. • Most healthcare providers are committed to making
alternative payment models work. About 23 percent
of those surveyed expected to connect half of their
payments to a value-based care model by 2019, a
year later than the federal goal set by HHS.
• In order to be successful and take advantage of the
opportunity providers will need to refocus their
revenue cycle management strategies to include
more data analytics tools, population health
management, and better patient billing techniques.

4. DATA ANALYTIC INVESTMENTS WILL HELP TO
MAXIMIZE CLAIMS REVENUE AND TRACK OUTCOMES
• Value-based care hinges on care quality improvement.
Providers must invest in data analytics or vendor-
sponsored systems to analyze quality metrics and
monitor their progress with improvements.
• Private and government payers are increasingly providing
financial incentives in addition to their normal fee for
service payments that demonstrate and improvement in
care delivery and reduce healthcare costs. However,
doing nothing is not the answer as providers can face
financial penalties for not achieving quality and cost
standards.

5. Robust data analytics tools will help maximize
claims revenue in a value-based payment
arena, especially since providers can review
their performance in real-time. This will enable
them to and improvements to claims
management systems. In addition to measuring
and maintaining performance, healthcare
analytics tools are beneficial for monitoring
claims management systems, which will allow
modifications as the data comes into view.