The healthcare industry today faces many challenges. Gaps in communication between patients and their care teams create confusion, delays, and anxiety. Doctors, nurses, and broader care teams are faced with busy schedules and limited resources. Hospital leaders are under pressure to increase efficiency, but they don’t have the critical analysis and technology to support their efforts. The cause is broken processes and inefficient workflows, which results in significant waste and a poor patient experience. Solutions on the market today only focus on a small piece of the problem that needs to be solved — and they’re not actionable in real-time. But changes in how services are billed are forcing hospitals to evolve, and advances in technology have created an opportunity to reimagine the way care is delivered.
Optimizing workflows, fixing journeys
The tangible value we deliver is in optimizing workflows and patient care journeys. This requires changing the current models of care. We developed the Clarify Health solution by listening to what stakeholders in healthcare expect and need from each other.
What patients want
Patients want precise, personalized, high-quality care at an affordable price. More specifically, they expect:
- Easy access to quality care providers
- Respect for their time
- The fastest recovery possible
- To get back to fully enjoying life
- Care they can afford
What clinicians want
Doctors, nurses, and other caregivers face demanding schedules that leave little time for meaningful engagement with patients. They are open to change, but sometimes skeptical of ineffective management strategies. They want to focus on what really matters:
- Increased time with patients
- Real-time feedback on patient progress
- Less administrative burden
- Employing their most valuable skills
What health systems want
The healthcare industry is inefficient. Hospitals face pressure from all sides to deliver a service promise of higher value care. Health systems want to:
- Optimize workflows to eliminate excess cost and wasted time
- Evolve and adapt successfully to the new value-based approach
- Monitor program progress and efficiencies
- Use technology to better engage and communicate with patients
- Build patient trust and loyalty
- Increase clinician satisfaction with the care they provide
Shifting trends and industry pressure
The healthcare industry is transitioning to a fee-for-value system, where a single facility will assume accountability for the overall outcomes and cost of a patient's journey of care. We believe that focusing on delivering great care to patients will ensure success regardless of the specifics of the payment model. The Clarify solution is designed with this philosophy in mind. That said, the Centers for Medicare and Medicaid Services (CMS) are leading the transition with the Comprehensive Care for Joint Replacement (CJR) and Bundled Payment for Care Improvement (BPCI) programs. These programs present not only a challenge for health systems, but also an opportunity to transform how they deliver care across the continuum.
Medicare’s Comprehensive Care for Joint Replacement (CJR) program holds a hospital accountable for the cost of the entire episode of care, from hospital admission until 90 days after discharge. Medicare sets a target price, and hospitals earn a bonus or penalty depending on performance relative to that target. Hospitals can increase their potential bonus by performing well on quality and patient satisfaction metrics.
The Clarify solution can help you maximize the value of this program. Contact us to find out more.
Key CJR Facts:
- Started on April 1, 2016
- Makes hospitals accountable for entire episodes of care
- Could impact hospital revenue +/- 50% for the relevant procedures
- Allows gainsharing with patients and other providers who directly serve the patient
- Applies to ~800 hospitals (download the list below)
- Will roll out gradually over the next five years
CMS launched the Bundled Payment for Care Improvement (BPCI) program in 2013 to help lower costs and improve patient care. This voluntary pilot program is currently testing four different models.
Key BPCI facts:
- BPCI has already launched and is not accepting new participants
- Participants can choose from 48 different episodes of care
- Of the four BPCI models, Model 1 and 4 are less common and only include the inpatient stay
- Model 2 and 3 include in the episode any post-acute care and other related services for a defined period of time after discharge
- Model 2 and 3 participants earn a bonus (or penalty) based on cost performance
- Model 2 and 3 participants are initially paid fee-for-service, with a year-end reconciliation
The Clarify solution can help you manage your BPCI bundles. Contact us to find out more.