Health systems executing a value-based strategy need a strong foundation of primary care physicians (PCPs) to reach the highest levels of care management, but traditional physician compensation models miss the mark when aligning incentives to achieve success. Fee-for-service (FFS) models are ill-suited because they rely primarily on volume production to pay physicians, 而通常忽略了利用率管理. Value-based compensation structures that align incentives with successful care management can unlock tremendous value for the system, and PCPs can earn substantially higher compensation than peers operating under FFS models.
注重初级保健
A variety of market forces are driving health systems to become value-based entities, 包括监管变化, such as increased flexibility for value-based compensation in the 拟议的斯塔克法规则. 付款人对价值的激励也越来越多, 比如共享储蓄计划, 这些“可信赖医疗组织”, 以及CMS提出的2021年初级保健第一模式. Given the high-impact role that PCPs play in utilization patterns and operating expenses, health systems have placed a heightened focus on recruiting PCPs to improve patient access and manage the total cost of care. 如果您的组织遵循此策略, adopting a value-based model with capitation plus risk-based elements for your PCPs may be an effective approach. PCPs who are highly successful in driving down overutilization and reducing the specialist medical expenses of a managed population can deliver extraordinary value to the health system and improve the bottom line of risk-based contracts.
调整bet8网站备用薪酬
It is important to align physician compensation with the structure of the managed care contracts.
- To improve financial performance, the compensation paid to physicians should 激励行为的改变 推动了这一进步. 例如, a group that holds a 全面的风险 capitation contract while paying the PCPs based on WRVUs has misaligned incentives by compensating the physicians to increase productivity but not to manage the cost of care. Effective compensation models for groups with capitation plus risk bonuses will align compensation with success at managing the total cost of care and building value-based patient panels.
- 调整bet8网站备用薪酬与管理医疗合同 降低财务风险 by ensuring that significant increases in physician compensation are tied to optimized care utilization under the managed care contracts instead of incentivizing higher utilization through FFS-style compensation.
- 最后, risk arrangements that fall under the Stark law risk exception might not have the same fair market value constraints, potentially availing higher compensation than could be supported under traditional approaches.
更好的协调导致更好的人口健康
心电图结果 2019基于风险的承包与bet8网站备用报酬调查 illustrate that organizations with the highest degree of financial alignment with providers also demonstrate the most success in risk population contracts. The survey data indicated that physicians paid under net income models had a significantly lower medical expense ratio, 中位数为63%, while those paid under a model that relied on modest quality bonuses had an average medical clinical expense ratio 22% higher, at 85%. Figure 1 below shows the resulting medical claims expense ratio for three different types of compensation mode.
通过对心电风险调查中市场数据的分析, 心电图 has been able to demonstrate that traditional market benchmark compensation values do not accurately reflect compensation paid to physicians in value-based entities.
风险越大,回报越大
Typically, prospective capitation payments are made on a per member per month (PMPM) basis. However, there is an array of structures and levels of risk shared across 均摊安排s.
- 在一个 全面的风险 均摊安排, the medical group is responsible for the total cost of care of the capitated population, 包括所有设施, 专业, 药品索赔.
- Partial-risk capitation typically means the medical group is responsible for the 专业 expenses and is not at risk for the other medical expenses of the capitated population.
- 初级保健人均 arrangements typically mean a primary care group is paid a PMPM fee to deliver all primary care services. 初级保健人均 may include carve-outs that pay for some services on an FFS rate, and may also include bonuses for achieving financial savings or performance incentives.
Figure 2 shows the level of risk for the cost of care along a continuum of 均摊安排s.
随着风险水平的提高,资本可能会增加
smaller, but the total potential compensation paid to high-performing
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解锁的价值
Aligning compensation and reimbursement funds flow is one of several challenges that medical groups must manage when transitioning to a value-based model. When embarking on an organizational strategy to accept more value-based risk, 不要忽视bet8网站备用的激励设计. 基础设施带来的综合挑战, 护理团队, 而操作要求可能是一个重大障碍, but they are no worse than misaligning physician compensation and organizational strategy.
心电图 is your partner for developing and managing your value-based strategy. 了解更多bet8娱乐与基于价值的组织合作的信息.
阅读更多2020年9月30日发布