Philip Betbeze, for HealthLeaders Media , August 21, 2015
The value of participating in risk-based reimbursements is not only in the (short-term) gainsharing achieved, but in redirecting processes and protocols to achieve (long-term) lower costs and higher quality healthcare.
I was talking with a source the other day for a story I’m working on for an upcoming issue of HealthLeaders magazine. During our conversation about a related topic, we chatted briefly about how hospitals and health systems are torn between whether participation in risk-based reimbursement is the right thing for the organization or not—that is, if they have a choice. Most still do.
Such initiatives make no secret about shifting risk to the provider. Broadly, the carrot is the opportunity to “gainshare,” or keep at least part of the savings achieved over the life of the contract. This makes such contracts not only a risk for the organization, but for the careers of the executives who are charged with executing against them.
A baseline is set, and rewards or gainsharing can result if a provider, be it a hospital or health system or an individual physician, generates savings above that baseline. Those savings come from reduced readmissions, or from better postacute care, or from better adherence to care protocols—or any number of other metrics. Physician alignment is a prerequisite, of course.
The concern from many in top leadership is generally not around their organization’s ability to perform under the first such risk sharing agreement. There’s an abundance of low-hanging fruit to be found in standardization, operational efficiencies, and improvements in pre-and post-acute settings, which are often the responsibility of the risk-taking entity to arrange in the most effective and efficient way possible.
