September 27 2016 | 0 Comments | 346 reads Average Rating: 3

Hitting the Value-Based Reimbursement Target: Six Key Focus Areas

by EXL Healthcare in Population Health

Talk about the need to improve population health, enhance the overall care experience and reduce costs has been running rampant as healthcare organizations look to succeed under value-based care. While there’s been plenty of dialogue regarding the need to hit this triple aim, the rhetoric on how to actually zero in on this somewhat elusive target has been far less abundant.

We’re ready to fill the void for your healthcare provider organization with some practical action steps in six key focus areas.

Focus Area #1: Planning and Goals

It’s absolutely essential for your organization to have a plan that includes specific goals. To accomplish this, you need to:

  • Conduct a gap analysis that sheds light on what you need to do to reach specific goals
  • Stay up to date with best practices
  • Identify a provider champion
  • Assemble a quality improvement team
  • Evaluate needs/goals based on what your patient satisfaction survey says

Focus Area #2: Change Management

It’s important for your organization to cultivate a culture that is receptive to change. To successfully achieve this objective, you need to:

  • Engage all departments
  • Be transparent internally with providers and give the feedback necessary to align behavior to outcomes
  • Communicate the impact of changes, both good and bad
  • Look outside the box for your next change opportunity
  • Make each staff member aware of how they individually contribute to overall goals

Focus Area #3: Communication

To successfully move forward, everyone needs to know where you are going. It’s important to continually communicate to staff and patients.

Internal Communication

  • Schedule all-staff meetings for education on trends and quality
  • Maintain internal transparency with providers on goals/impacts of actions to drive behavior change

External communication

  • Create a patient advisory council and send patient satisfaction surveys
  • Develop open communications with hospitals and community agencies
  • Find a cadence and platform(s) that works with your patient populations
  • Use your website, portal and email as a bi-directional communication tool

Focus Area #4: Finances

It is absolutely essential to treat your organization’s budget with the same care and attention that you give to your own finances. To do so, you must continually address the following areas:

Network Care

  • Fix referrals then leakage
  • Increase after hours care options
  • Consider bringing out of network high cost series inside your network

Cost Containment

  • Operational costs (workflow, staffing/provider ratio, supplies)
  • Enable staff to work at the top of their skills set
  • Increase preventative series


  • Readmissions within 30 days

Revenue Optimization

  • Negotiate competitive pricing
  • Increase providers/services

Focus Area #5: Quality

To succeed in the value based world, your organization must constantly address quality matters.

  • Complete all quality measures across payer contracts in a single place
  • Use a reporting dashboard for increased visibility into your current performance
  • Focus on the most achievable measures first
  • Prioritize remaining gap closure based on which gaps are closest to your contracted threshold
  • Get creative on the most difficult gaps to close

Focus Area #6: Use Technology to Your Advantage

To successfully achieve the triple aim, it’s important to continually find ways to better leverage technology.

  • Use analytics to make sense of disparate data
  • Leverage analytics to manage and improve population health, network performance, stakeholder outreach and outcomes
  • Use analytics to identify, engage and measure

These are just six examples of areas that need to be addressed to achieve the triple aim. What other areas could come into play as your organization seeks to improve care, enhance the patient experience and lower costs?

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