The COVID-19 pandemic has highlighted the need for providers to create alternative revenue sources and opportunities. Most providers still rely on a fee-for-service (FFS) payment model that rewards them for volume. When the pandemic began and patient demand for services dried up, so did revenue. In the scramble to provide services to patients and offset lost volume, 提供商快速实现 远程医疗 以及其他虚拟bet8娱乐, spurred on by unprecedented government and commercial payer support that included reimbursement for 远程医疗 visits equal to that of an in-person visit.
While these measures may have helped with FFS revenue in the short term, 远程医疗 visits alone cannot make up the revenue loss from the overall decrease in volume. 基于价值的支付(VBP)模式, 另一方面, enable providers to generate non-visit-based revenue by maximizing opportunities to increase the value to patients, 健康计划, 和雇主. The explosion of digital health used during the pandemic can help providers optimize their performance under value-based models. These digital competencies and capabilities will continue to pay dividends as VBP models proliferate in response to market forces shaping the industry’s COVID-19 recovery and the long-term delivery of care.
甚至在COVID-19之前, several key market forces were driving providers to adopt VBP models—site-neutral payment policies, 人口老龄化, 将利用, bet8网站备用短缺, 政策法规, 等. But these forces have become more pressing in the wake of the pandemic, as providers seek to manage their impact in conjunction with declining revenue. 下面, 我们将描述其他市场力量如何, 即付款人倡议和数字医疗采用, have accelerated as providers seek ways to generate revenue and manage care delivery virtually.
推动基于价值的护理(VBC)采用的市场力量
支持和扩展VBP的付款人倡议
Admittedly, over the past decade, the transition to value has been slower than initially projected. However, COVID-19 has made it clear the time for value is now—and payers are taking notice. CMS has stated that its FFS system “is insufficient … because it limits payment to what goes on inside a doctor’s office. 向以价值为基础的体系的过渡从未如此迅速 紧急的.” CMS has signaled that it will likely continue to implement and expand VBP programs in order to ensure healthcare access, 创新, 改善了治疗效果.
商业支付方也表示更注重价值. They are offering economic support to providers who agree to enter value-based arrangements. 例如, 蓝十字NC宣布了一项名为“加速实现价值”的倡议, which focuses on immediately moving primary care practices into value-based arrangements. In exchange for advance payments, practices must join Blue Cross NC’s VBC程序 by 2021, after which they have the option to receive capitated payments starting in 2022.
Providers who can create a steady source of payments independent from in-person visits will be in a stronger post-PHE financial position. Providers looking to take advantage of payer acceleration of VBP should 评估他们当前的能力 并确定哪种模型最适合他们的组织. With more advanced capabilities, the greater the degree of provider risk-taking opportunities.
采用数字医疗为VBP带来成功
在VBP模式下实现财务收益最大化, providers should take stock of digital health solutions (some of which they may have recently implemented to manage COVID-19) that will optimize performance and address some of the challenges of VBP models.
Consumers who utilized virtual care during the PHE will continue to drive the demand for 远程医疗 and remote monitoring to avoid crowded waiting rooms, 任命延迟, 潜在的暴露. Providers and patients have discovered that these technologies can close gaps in care and improve the patient experience. Providers are looking to use these technologies to enhance clinical offerings.
Organizations that want to expand need to examine the spectrum of complexity, 技术, 以及所需的能力. Virtual visits can be more transactional and require limited infrastructure, while home and community-care programs will draw on several resources, 比如护理协调, 医院墙外的科技, 社区参与. 数字 health strategies are most successful when they match the resources and needs of the provider. The graphic below illustrates how providers can adopt digital health strategies to help achieve outcomes that provide success under VBP models.
数字
取得VBC成功的卫生战略
Many of these technologies were implemented with the hope that reimbursement would follow. While the pandemic forced payers to expand 远程医疗, the long-term commitment remains unknown. 能够向付款人证明其价值的提供者(例如.e., 更高质量的, 提高患者满意度, and lower costs) are more likely to be successful in negotiating the long-term inclusion of 远程医疗 services into their commercial contracts. 与此同时, providers should think about the return on investment that digital health capabilities can provide under VBP models.
Providers who are focusing their strategies for COVID-19 recovery will need to embrace the increased focus on value-based arrangements and 远程医疗 adoption, 两者的结合提供了最大的成功.
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