Hospitals are an essential part of the healthcare landscape. They are responsible for providing critical care, filling key care gaps, and improving health outcomes in the communities that need it most. While we know just how important these institutions are, the healthcare landscape continues to evolve, creating new challenges that require hospitals to undergo organizational or financial shifts to ensure continuity of care. Securing the long-lasting growth and vitality of hospitals amid the shifting healthcare landscape is more important now than ever, and adopting risk is a salient approach to achieving that outcome.
Taking on Risk: Why Now, and What Could it Look Like?
Adopting risk, or entering into risk agreements with payers, is not just an emerging trend among healthcare institutions. Rather, it’s an industry-wide shift that is being recognized by the Centers for Medicare and Medicaid Services (CMS). Earlier this year, when outlining the strategic direction of the agency in May, CMS acknowledged that “a growing proportion of Medicare and Medicaid beneficiaries are in global downside risk arrangements.” In essence, providers taking on some degree of risk is starting to be seen as inevitable.
While the concept of taking on risk can seem intimidating or burdensome, risk does not have to look the same for every hospital and often will not look the same. From entering into value-based care arrangements to assuming full risk, taking on the right strategy and degree of risk can provide hospitals with the resources and tools they need to continue delivering the highest quality care while optimizing their budgets for long-term sustainability.
To identify the most effective strategy for hospitals to adopt risk, it’s essential to first gain a complete understanding of the hospital’s ability to take on risk in the first place.
Assessing the Potential to Take on Risk
Determining whether a hospital is in a position to take on risk requires an in-depth, multi-step assessment that seeks to measure the hospital’s financial and organizational health. Our team of experts works together with hospitals to guide them through this process with the overall goal of ensuring they are receiving the support they deserve for the high-quality care they deliver for patients, families, and communities.
Managed Care Operations Assessment
The assessment begins by getting the full picture of the hospital’s structure and its contracts with health plans. Contracts that are not optimized for the hospital’s success can hinder its ability to provide high-quality care and maintain operations.
To get the full picture, we request relevant financial and organizational data from the hospital, along with its current contracts with health plans. Using the data, we can identify any discrepancies between expected and actual payments, identify areas in which the contract may or may not be the most effective, and pinpoint areas of growth.
Measuring Impacts of Uncompensated Care
Given the additional requirements enacted in H.R. 1, we then analyze how these will impact the uncompensated care and assist with the development and implementation of programs to manage the uninsured like any other member in a health plan.
Reviewing Quality Metric Requirements
Once that is complete, we examine all the quality metrics that the hospital is required to meet through those existing contracts to determine whether they are achievable for the institution.
Looking Ahead: Crafting Tailored Strategies to Support Hospital Vitality
Using what we’ve learned throughout the assessment process, our team will begin developing risk strategies in accordance with the hospital’s ability to take on risk, comfortability assuming risk, and any applicable state guidelines.
Our team understands that assuming risk as a provider can be daunting. That’s why we’re committed to working closely with hospitals to navigate the evolving healthcare landscape; evaluate the strategies that will allow for the institutions’ long-term success; and ensure that providers who deliver high-quality care can continue their work for the communities they serve long-term. Learn more about our services by contacting us today.
