Impact of Value-Based Purchasing on Healthcare Management

 

 

Healthcare managers play a crucial role in this transition, collaborating with physicians and other stakeholders to make informed decisions on budgeting, policy, and patient care. The value-based model demands that managers prioritize patient experience, clinical efficiency, and adherence to CMS guidelines. Building a collaborative culture and fostering teamwork are essential to navigating these changes successfully.

Shared Risk Models in Healthcare

Shared risk models introduce a different approach by linking financial rewards and risks with healthcare outcomes. Under these models, providers share savings with insurance companies if they successfully reduce costs and improve patient outcomes. Conversely, if costs exceed expectations or outcomes fall short, providers share in the financial losses.

Benefits of Shared Risk Models

Evidence suggests that shared risk models can lead to substantial cost reductions and improved clinical performance. For instance, in 2017, shared risk models contributed to a 3.5% decrease in total care costs and improved clinical quality performance by 9.2% in California. Additionally, patients in these models experienced significantly lower out-of-pocket costs compared to those under fee-for-service arrangements.

Challenges and Strategies for Managing Shared Risk Models

Managing shared risk models requires healthcare organizations to carefully monitor and balance their financial risks. Providers must demonstrate that they meet quality standards while maintaining low operating costs. Failure to achieve these standards can result in negative financial impacts.

To address these challenges, healthcare managers need to focus on maximizing reimbursement potential, improving care quality, and controlling costs. Effective decision-making and strategic planning are crucial for success in a shared risk environment.

Developing a Strong Organizational Culture

A robust organizational culture is fundamental to the success of value-based and shared risk models. Building a culture that aligns with the organization’s values and goals can drive better performance and outcomes. Key strategies for fostering a strong organizational culture include:

• Promoting Communication and Collaboration: Encouraging open communication and teamwork among employees helps align the organization’s vision and values.
• Leading by Example: Leaders should model the behaviors and attitudes that reflect the organization’s culture and goals.
• Focusing on Results and Accountability: Setting clear goals and performance standards and holding teams accountable can drive success and align efforts with organizational objectives.
• Prioritizing Employee Well-being: Ensuring employees are supported and satisfied in their roles contributes to a positive work environment and overall organizational success.

Conclusion

The shift from fee-for-service to value-based and shared risk models represents a significant transformation in healthcare management. These models emphasize quality, efficiency, and patient-centered care, aligning financial incentives with improved outcomes. Effective implementation and management of these models require strong organizational culture, strategic planning, and a commitment to continuous improvement. By focusing on these areas, healthcare organizations can enhance their performance, reduce costs, and deliver exceptional care to patients.

References

Beheshti, N. (2018, September 17). 3 Strategies To Build A Strong Company. Forbes. Retrieved from https://www.forbes.com/sites/nazbeheshti/2018/09/17/3-strategies-to-build-a-strong-company-culture/#37a95bd32732