As healthcare providers continue to take on additional risk, they are looking for partners who not only understand their new reality, but are also willing to share risk. This new reality requires providers to shift their focus to creating a positive patient experience, reducing cost and meeting all quality and safety metrics. To help providers reach their goals, forward-thinking suppliers already have (or are in the process of) implementing risk-sharing contracts.
How do we structure our risk-sharing partnerships? One way is through a bundled payments strategy. There are 48 bundles that the Centers for Medicare and Medicaid Services (CMS) has identified initially for payment. We start there, and identify multiple baseline metrics for a certain bundle or disease state, such as:
• A provider's current length of stay
• Complication rates
• Supply utilization and more
This helps us standardize our approach per hospital or system. Then, we work with institutions around surgical determination – open or minimally invasive – through a clinical, operational and financial education perspective. We can also collaborate with the institution to provide kits containing products that would be utilized for the specific procedure and identify ways to create a standardized approach from pre- to post-surgical care.
Through evidence-based medicine, we learn together how to get patients back to a healthy state, reducing complications, length of stay and possible readmissions. The metrics are where the risk sharing comes into play. From the baseline metrics established at the beginning, we set goals around generating improvements through our services and solutions. Some of those services and solutions could be worth a certain amount in a fee-for-service world, but if we risk share and tie into an episode of care, we will share in those savings with the provider.
Continuous improvement and sustainability requires close monitoring of the results. Our team partners with the hospitals and provides them with ongoing dashboards that allow us to follow the results and create a sustainable approach to value-based care.
Risk-sharing is a journey on which the provider and suppliers are just embarking. What would an ideal risk-sharing partnership look like for your organization?