Ask 100 integrated health organizations how they’re preparing to deliver Value-Based Care and most likely, you’ll receive 100 different strategies back in return. When the set of performance- based payment criteria linking financial incentives to provider performance was originally proposed by CMS, there was no navigational roadmap included, so providers were left to fend for themselves in figuring out how to optimize their organizations to adapt to the new set of requirements and what exactly they needed to measure
Another important aspect in value-based care programs is the role that patients and their families and/or caretakers play in mitigating costs and helping providers to meet the challenges of valuebased reimbursement models.
Many integrated health care providers are challenged with reimbursement issues arising from their unique service niche in the health care market. Whether your organization is a Community Mental Health Center, FQHC or a Patient-Centered Medical Home, there are several factors to consider to enhance profitability.
Typically, many organizations use the “net denials as a percentage of net revenue” as the primary KPI when measuring denials, which involves tracking the total amount written off that has not been challenged with an appeal.