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Navigating Payment Reform and the Changes to Come

by Evan Grossman, VP of Consulting Services

The idea of payment reform in health care has long been discussed. But the conversations have now become louder and more urgent as costs reach new, precarious heights. Unless something is done to stem the tide, government health care spending is projected to rise dramatically in the coming decades. In a September 2011 letter to Congress, the American Medical Association noted the cost of permanent payment reform at nearly $300 billion, with additional short-term interventions skyrocketing costs to an estimated $600 billion by 2016.*

The federal government is looking to improve quality and population health, and reduce health care costs through legislative and regulatory activity, as well as collaboration with the private sector. Most of us are familiar with the initiatives out there and the complexity they can add to the landscape: Shared Savings programs. Meaningful Use. Patient-Centered Medical Home (PCMH) and Accountable Care Organization (ACO) models. These, along with other payment reform provisions developed by the CMS Innovation Center, all work to move the payment model beyond fee-for-service, to a landscape where providers are properly compensated for quality care, with overall costs under control.

With a multitude of alternative options, how can practices and hospitals best prepare for the inevitable payment reform changes? athenahealth has offered a core set of capabilities on which to focus, which can not only position a practice for success under new reimbursement models, but can also help you thrive now.

1. Patient relationship management -- Understanding patients' health care needs and establishing effective patient communication
2. Influencing clinical protocols -- Consistently executing on required tasks when a patient is being treated
3. Referral management -- Enabling you to ensure that patients get the best care at the most reasonable cost
4. Connectivity and data exchange -- Exchanging data with other providers and services, which can both improve care and lower costs
5. Counseling patients about medical costs -- Informing patients, providing them with options, and enhancing relationships

As with most high-impact changes -- Meaningful Use Stage 2 requirements, the ICD-10 transition -- it's best to prepare early. For more information, you can check out our on-demand webinar (registration required). And, as always, we'd like your feedback: How do you view payment reform, and how are you preparing?

*AMA-sponsored letter to Jeb Hensarling, Co-Chair Joint U.S. House of Representatives Select Committee on Deficit Reduction, September 20, 2011,, page 1

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