Finding ways to create a payment model that rewards high-quality outcomes, reduces avoidable costs and protects payer and provider margins is the focus of the Monday morning education session, "Bridging the Payer and Provider Gap: Creating a Shared-Savings Payment Model for Increased Quality and Efficiency," at the HFMA's ANI: The Healthcare Finance Conference in Orlando.
Navigant Healthcare will partner with Blue Cross Blue Shield of Alabama to facilitate the session, which is geared toward provider CFOs and managed care executives interested in new ideas for partnering with their top commercial payers to manage the payment and delivery transition toward a lower cost, higher quality delivery system; quantifying core, evidence-based costs versus avoidable costs; and designing payment mechanisms to incentivize value without increasing administrative costs.
[See also: BCBS of Minnesota launches new payment model with four health systems]
From Navigant Healthcare, Richard Bajner, Managing Consultant, and Mike Nugent, Managing Director and co-author of the new book, Accountable Care Organizations, Your Guide to Strategy, Design, and Implementation, will speak on strategies for creating a network that protects margins for both payers and providers.
One vital lesson for attendees, Bajner says, will be a greater understanding of the impact current changes to payment models are having on payer and provider margins and ways that organizations can adapt their payment models to reduce waste and avoidable costs. "We will discuss how payers can take a deliberate approach to engaging with their providers to create a network that allows payers and providers to meet their bottom lines," he says.
"Another core principle we will discuss is evidence-based cost," Bajner continues. "What would it cost if you could get the waste out of the system?" With Medicare and Medicaid threatening to reduce reimbursements and not pay for unnecessary expenses, organizations need a system that rewards high-quality outcomes and efficiencies. Bajner also suggests that changes to the payment model should coincide with changes to the clinical model to reduce cost variation by physician and reduce readmission rates.
Eddie Harris, Vice President, Health Management at Blue Cross Blue Shield of Alabama will detail their experience implementing value-based contracting and reimbursement models. Through this case study, Harris, Bajner and Nugent will illustrate how providers can take a measured approach to developing more cost-efficient managed care.