In today’s value-based healthcare marketplace, pay-for-performance initiatives are everywhere you look. There’s the CMS Hospital Value-Based Purchasing program, the Physician Quality Reporting Program, public quality reporting websites (e.g., HealthGrades® and Hospital Compare), the proliferation of Accountable Care Organizations (ACO) nationwide, and Meaningful Use. Other terms associated with value-based care include incentivized payments, bundled payments, risk sharing, capitation arrangements, gain sharing, risk-adjusted care, and population-based payments.
Given these changes, the tides certainly seem to be moving away from volume-based reimbursement toward a model in which quality is paramount. This is evidenced by CMS’ January 2015 announcement of its “Better, Smarter, Healthier” campaign aimed to tie 30% of traditional, or fee-for-service, Medicare payments to quality or value by the end of 2016.
The overarching idea is that by improving the efficiency and quality of care, we’ll be able to lower costs, and ultimately, enable better outcomes. Over time, we’ll likely witness many payers and providers move toward contracts in which shared risk between the deliverers of care and the financiers of that care. It makes sense to explore whether this shared risk model could work in a provider-HIM outsource vendor relationship. Just as payers and providers share risk, organizations can share compliance and financial risk with their outsource vendor in order to achieve greater efficiency and shared savings.
The cost savings alone that can be gleaned from shared risk partnerships are significant. According to CMS data released in August 2015, 20 ACOs in the Pioneer ACO Model and 333 Medicare Shared Shavings Program ACOs generated more than $411 million in total savings in 2014. The Medicare Shared Savings Program rewards ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first. According to CMS, 92 Shared Savings Program ACOs held spending $806 million below their targets and earned performance payments of more than $341 million as their share of program savings.
Benefits Of A Shared Risk Contract With MRA
Why can’t these same principles be applied to an HIM outsource vendor relationship? Let MRA help you explore how a shared risk partnership can provide the following benefits for your organization:
- Cost reduction
- Access to HIM knowledge and resources
- Ease of response to fluctuations in volume and/or DNFB
- True alignment with an HIM vendor partner
- Indemnity against compliance problems