As healthcare continues to evolve, providers must find new ways to address an increasingly complex environment. One of the most challenging aspects is payment for care in a fiscally sustainable manner.
In a shift from a fee-for-service model to one that relies on multiple performance benchmarks – financial and qualitative – to incentivize providers to take greater responsibility for the total care of a patient, it’s important to recognize the larger impact on the patient and population health. Payers are holding providers accountable for the patient’s overall health while also incentivizing them to manage the total cost of care. A prime example of the start of these new reimbursements is Medicare Shared savings programs that hold providers accountable for managing total cost of care and qualitative metrics, such as patient readmissions rates.
A challenge that many providers are facing as they develop new initiatives is that many of them seem to have a negative direct ROI at first glance. That’s where we at Blaze Advisors see the need to expand the analysis of the ROI for new initiatives to what we are calling the “double bottom line”. The double bottom line is looking beyond the immediate direct ROI of an initiative and following the dominoes of care to all areas of impact.
Here's one example:
In a recent project with a 600-bed health system, Blaze helped the management team understand that program ROI is more than revenue minus expenses; it’s also the sum of its efficacy in reducing the inappropriate use of the most expensive resources, inefficiency of managing cases outside of practice scope, and bonuses/penalties exacted by third party payers and stakeholders. In this light, populations suffering from polychronic and behavioral health conditions extract extraordinary resources, with minimal reimbursement to providers. One way to offset this trend is to prioritize effective preventative and community-based programs such as disease screening, transitional care support, clinical consultation to allow for practicing at top of license, and high performing networks of care.
The questions are complex, as are the answers - but there are proven solutions that work.
Blaze is here to help operating partners find value in investments and to see the big picture clearly. It’s important for success in the new reality.