Don't Go It Alone: Changes to How Payers Reimburse You
In the last quarter of 2023, TRIARQ Health was honored to be a sponsor of the American Association of Orthopedic Surgeons’ Value-Based Care Class. Physician leaders from across the country gathered for this online class. They had the opportunity to hear from other practice leaders who have taken the brave step forward to enter value-based, or bundle payment, agreements with payers.
The experiences shared throughout this class were mixed, although not surprising, because moving from traditional fee-for-service arrangements takes planning and careful consideration of every step along the patient’s journey.
Presentation Recap
One of the takeaways repeated throughout the program was the importance of finding a company or advisory partner to assist your practice in making this transition. I echoed this sentiment when I also addressed the attendees of the AAOS class. Here’s a quick recap of my presentation given on December 12, 2023:
What creates success in value-based care programs?
A practice considering transitioning into an alternative payment arrangement should begin with an in-depth practice assessment of its readiness and build a plan for success. Simply put, a practice needs:
- A well-executed assessment
- A clinical pathway based on evidence
- The means to deploy the pathway
These three steps require the expertise of a partner or an advisor with experience coordinating and synthesizing assessments, building a pathway or plan, and a track record of deploying such a plan.
What are the things that lead to failure in an alternative payment arrangement?
- Clinical failure
- Patient adherence
- Poor ongoing communication coordination
The way TRIARQ Health helps practices succeed:
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Care Management: Personalized support from TRIARQ care coordination staff to improve clinical and financial outcomes.
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Clinically Integrated Networks: Establish a curated network of physicians and allied health professionals to support thoughtful utilization while delivering care that aligns with physician-defined clinical pathways.
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Analytics: Utilize systems that translate patient stratification, clinically integrated network monitoring, financial performance forecasting, and performance optimization into actionable insights to improve outcomes and maximize revenue.
The Bottom Line: Independent specialty practices should take advantage of the opportunities that value-based or bundled payment arrangements can yield. And working with an expert organization capable of setting your practice up for success is essential.
Why TRIARQ Health?
TRIARQ Health is an enablement organization that supports independent specialist physicians in establishing Integrated Practice Units, which we call care Circles. We do so through technology and service offerings, and our approach is to support independent physicians via services and technology that enable them to enter alternative payment arrangements with payers and risk-bearing entities.
Our recent blog, “Are You Ready to Stop Leaving Money on The Table?” outlines the type of partner or advisor independent specialty practices that should be sought before accepting the risk associated with bundled payment arrangements. I encourage you to learn more about the opportunities and partners available to help you succeed and, most importantly, remain independent.
If you want to learn more about alternative payment arrangements or how to find out if they are available in your marketplace, let’s connect.