Value-based care is slowly emerging as the new alternative to healthcare payments as opposed to fee-for-service reimbursements. With a focus on quality versus quantity, this type of reimbursement aims to refresh the healthcare system by reducing costs both for providers as well as for patients.
Fee-for-service models tend to lead to fluctuating costs. That usually forces healthcare organizations to spend more money on treating patients but without any visible improvements. Value-based reimbursements, on the other hand, are driven by data that providers track, collect, and use to improve their services. This model can help medical practices reduce denials, improve patient satisfaction, and increase their profitability.
In fact, value-based care has proven to have quite a few advantages for healthcare providers. It can help them manage more patients which in turn can lead to fewer situations where services are performed out of network. Also, providers are now able to care for patients that are in severe need of treatment and have a higher number of chronic diseases. Moreover, the market share is also increasing because patients now have more options to choose from than before.
The Need for Change
The value-based payment system is still fresh, and consequently, still evolving. For it to start growing roots, there are many necessary measures that must be taken into consideration. Providers should start drafting plans to help them transition to the new payment system while also carefully managing their resources and capabilities. This will require them to establish an internal organizational structure that will help them implement the necessary strategies and processes and at the same time, identify and maintain a balance of payment contracts. All of this should be done with the target of reducing costs and waste with reporting, improving quality and value, and aligning with payers’ expectations.
As this transition is slowly making its way in the healthcare system, providers face more and more pressure on reassessing their revenue cycles and finding alternative payment models. And, with providers facing an increasing number of denials, it becomes apparent that they need to be on the lookout for new solutions for handling value-based payments as well as fee-for-service models.
Automation is one of the answers to this problem.
Providers Are Slow to Adopt Automation
Unfortunately, most providers have been slow to adopt automation so far. According to a recent report, more than 30% of organizations still manage denials through manual processes although state-of-the-art technology is readily available to them.
This news comes as a surprise considering the fact that managing denials is not at all easy.
It is obvious that the transition from current healthcare revenue cycles to value-based care is not going to happen overnight. Alternative payment models are still exactly that – alternative. Tests are still required before they are implemented on a standard basis.
But as alternative and experimental as it is, automation is the future. More and more healthcare providers are considering implementing a claims denial management tool shortly, which comes to show that the industry is in need of more modern and efficient ways of dealing with denied claims.
Automation can help providers identify the leading causes of denials and improve the chances of a successful appeal. Not only that, but finding out what recurring issues you have when submitting claims will make it easier to know what your weak spots are, and what to focus on improving. Before fixing anything, it is crucial to know what went wrong, and automation is certainly a way to speed up the process.
How Automation Can Help Healthcare Organizations
One of the main reasons healthcare organizations fail to maximize their revenues is that they miss the opportunities to do so. Providers should consider outsourcing their revenue cycle processes, including claims denial management, and making sure they have the right people to handle them.
In-house billing should slowly start to become a thing of the past. Outsourcing is the future, and this becomes more and more evident when you think about just how many billing issues providers face. While they believe they’re handling everything quite well, the reality is that most of them don’t properly optimize the process of dealing with billing issues.
Right now, technology has advanced so much that most providers probably aren’t even aware of the options they have and are not taking advantage them. Doing your due diligence for each of your patients should be the standard protocol by now, and automation seems to present itself as a tremendous opportunity in that respect.