Bobbi Brown, MBA

随着医疗保健行业转向基于价值的支付(VBP)，财务高管必须从数量转向质量，并将其作为财务健康的关键驱动力——尤其是在负责任的医疗、质量衡量、共享储蓄和捆绑支付越来越受欢迎的情况下。为了应对这一持续的质量成本挑战，卫生系统必须了解其在临床质量衡量和提供护理成本方面的进展，因为临床质量是财务结果日益重要的预测因素。传统的按服务付费的环境强调数量，而今天的VBP模式将质量置于旧的衡量标准之前。

在经历了动荡的2020年和2021年之后，《纽约时报》将其总结为“衰落”，医疗行业的领导者们决心在2022年追求积极的变革。大流行仍有很大的影响，但卫生系统也将关注其他突出的业绩驱动因素，效仿其他行业的顶级表现，强调长期策略，并优先考虑消费者和数据驱动的决策。With these strategies in place, trends in the following six areas will determine organizational success in 2022 and have a lasting impact on providers and patients:

1. Health equity.
2. Patient safety.
3. Staffing.
4. Care delivery.
5. COVID-19 recovery.
6. Payment and payers.

随着医疗保健财务负责人计划2021年，他们可以预期COVID-19将影响他们的战略。流行病应对和恢复将继续主导该行业，为现有问题的新观点提供信息(例如，转向基于价值的护理和卫生公平)，并确定优先事项。与此同时，拜登政府将开始在美国医疗行业打上印记，进一步使2021年成为该行业的关键一年。

Healthcare finance teams can best navigate 2021 by monitoring and preparing to take action in five prominent areas:
1. Election impact.
2. Price transparency.
3. Financial forecasting.
4. Value-based care.
5. Health equity.

The long-term success of healthcare performance improvement relies on a sustainable infrastructure and strategic execution. Otherwise, improvement initiatives risk becoming one-off projects that don’t support ongoing advances in critical areas, such as critical areas, clinical outcomes, patient experience, and organizational cost.

Healthcare organizations can follow six steps for a sustainable, impactful performance improvement program:

1. Integrate performance improvement into strategic objectives.
2. Use analytics to unlock data and identify areas of opportunity.
3. Prioritize programs using a combination of analytics and an adoption system.
4. Define the performance improvement program’s permanent teams.
5. Use a best-practice system to define program outcomes and interventions.
6. Estimate the ROI.

The long-term success of healthcare performance improvement relies on a sustainable infrastructure and strategic execution. Otherwise, improvement initiatives risk becoming one-off projects that don’t support ongoing advances in critical areas, such as critical areas, clinical outcomes, patient experience, and organizational cost.

Healthcare organizations can follow six steps for a sustainable, impactful performance improvement program:

1. Integrate performance improvement into strategic objectives.
2. Use analytics to unlock data and identify areas of opportunity.
3. Prioritize programs using a combination of analytics and an adoption system.
4. Define the performance improvement program’s permanent teams.
5. Use a best-practice system to define program outcomes and interventions.
6. Estimate the ROI.

As the healthcare industry recovers from COVID-19, providers are re-evaluating the financial arrangements that motivate them to improve their processes while benefiting payers and patients.

随着大流行导致供应商数量减少，医院资源紧张，该行业再次迫切需要制定政策，在降低成本和增加收入的同时取得更好的结果。今后，医疗保健必须根据2019冠状病毒病疫情后的环境调整其支付方-提供商的绩效标准。

Renewed approaches to the following models will consider the impact of remote care, how to reimburse telehealth services, and the need for consistent payments to providers:

1. Pay for performance.
2. Bundled payments.
3. ACOs.

在COVID-19大流行的紧急阶段，几乎一半的美国医疗保健消费者推迟了常规和非紧急护理，使机构在所有护理环境中都面临重大收入损失。为应对医疗保健行业普遍面临的财务压力，美国国会已拨款1000亿美元，为医院和其他医疗保健提供商提供救助资金。但是，尽管医疗机构显然需要财政救助，但使用它(包括导航条款、条件和资格)却不那么直接。更好地理解这些救济计划和合规要求将有助于组织自信地优化这种援助。

在COVID-19大流行的紧急阶段，几乎一半的美国医疗保健消费者推迟了常规和非紧急护理，使机构在所有护理环境中都面临重大收入损失。
为应对医疗保健行业普遍面临的财务压力，美国国会已拨款1000亿美元，为医院和其他医疗保健提供商提供救助资金。
但是，尽管医疗机构显然需要财政救助，但使用它(包括导航条款、条件和资格)却不那么直接。更好地理解这些救济计划和合规要求将有助于组织自信地优化这种援助。

2020年是自2010年通过《平价医疗法案》(Affordable Care Act)和医疗保健从量到值的第一个过渡步骤以来的十年。
这份10年进展报告好坏参半。一方面，CMS对质量和成本的强调推动了患者和医疗提供者的上升趋势，再入院率大幅提高;on the other hand, organizations still need to simplify and consolidate value-based programs for more widespread positive impact.
随着该行业进入另一个有价值的十年，卫生系统是时候考虑到迄今为止这些项目的影响，并确保它们拥有在一个日益受价值驱动的行业中取得成功的流程和工具。

如今，医疗保健支付者必须开发新的业务模式，以应对行业在成本、访问和质量方面日益严峻的挑战。最好的新兴模式是简单和一致的，适应所有利益相关者的需求，并以患者/成员为中心。

Five key payer opportunities provide a framework for new models that will support the healthcare transformation goals of lower cost, better quality, and increased access:

1. Understand the impact of the Affordable Care Act.
2. Be ready for potential shifts due to regulatory impacts.
3. Understand how social determinants of health impact members.
4. Focus on provider relations.
5. Prepare for future trends.

As a performance-based incentive program, DSRIP (the Delivery System Reform Incentive Payment) is designed to help participating states reform Medicaid. To date, 13 states have implemented DSRIP and received a Section 1115 waiver from CMS to transform their Medicaid programs and align them with value-based reimbursement. These states have agreed to budget neutrality, transparency, statewide quality metrics, and frequent reporting of outcomes.

While each state’s program structure and objectives are unique, under DSRIP, participating states share three key goals:

1. Reducing the total medical spend.
2. Improving patient outcomes.
3. Establishing a direct link between provider performance and payment.

Since accountable care took the healthcare industry by a storm in 2010, health systems have had to move from their predictable revenue streams based on volume to a model that includes quality measures.
While the switch will ultimately improve both quality and cost outcomes, health systems now need the capability of tracking and analyzing the data from both clinical and financial systems.
A late-binding enterprise data warehouse provides the flexible architecture that makes it possible to liberate both kinds of data to link it together to provide a full picture of trends and opportunities.

Health systems that meet the 2018 Hospital Value-Based Purchasing Program measures stand to benefit from CMS’s $1.9 billion incentive pool. Under the 2018 regulations, CMS continues to emphasize quality. To reduce the risk of penalty and vie for bonuses, it’s increasingly critical that organizations leverage data to build skills and processes that meet more demanding reimbursement measures.

To thrive under value-based payment, healthcare systems must understand CMS’s four quality domains, and their associated measures, for 2018:

1. Clinical Care
2. Patient- and Caregiver-Centered Experience of Care/Care Coordination
3. Efficiency and Cost Reduction
4. Safety

我是一个勇敢的人，会花时间阅读医疗保险支付咨询委员会(Medpac)每年春天发布的报告。
The report shows the numbers of Medicare beneficiaries and claims are growing; healthcare organizations are increasingly losing money on Medicare; payment increases certainly will not keep pace with declining margins; and Medicare policies will continue to incentivize quality and push providers to assume more risk.
But the report also reveals that some healthcare organizations—referred to as “relatively efficient”—are making money from Medicare with an average 2 percent margin. How do you become one of these organizations? And how do you target and counter Medicare trends that impact your business?

When expenses exceed revenue, business has a financial problem. In healthcare, the focus has been on revenue for so long, we’ve lost sight of runaway costs brought about by high labor and technology expenses, inefficient use of resources, and supply waste. Recognizing the cost problem is a big first step toward solving it.

Five expense-controlling strategies can play a significant role in returning healthcare systems to a stronger financial position:

1. Refocus on labor management.
2. Manage employed physicians.
3.Change the patient encounter environment.
4. Augment standard approaches with technology.
5. Manage patient access and flow through the healthcare system.

随着新的、基于价值的支付结构、不断缩水的利润和不断减少的补偿，这种洞察力提供了一些新的方法来思考费用低效率和如何控制成本。

除了改善你的信息系统和教育你的员工关于管理收入的来由，还有很多改进的机会。Here are five suggestions to help health systems improve their revenue cycle management:

1. Trend and benchmark your healthcare data.
2. Use DOS to Mine Your Healthcare Data.
3. Constantly ask frontline staff for suggestions.
4. Monitor all payer contracts.
5. Maintain convenient and caring touch points with patients.

The shift from fee-for-service to value-based reimbursements has good and bad consequences for healthcare. While the shift will ultimately help health systems provide higher quality lower cost care, the transition may be financially disastrous for some. In addition, the shifting revenue mix from commercial payers to Medicare and Medicaid is creating its own set of challenges.
There are, however, three keys to surviving the transition:

1) Effectively manage shared savings programs to maximize reimbursement.
2) Improve operating costs.
3) Increase patient volumes.

With an analytics foundation, health systems will be able to meet and survive today’s healthcare challenges.