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Changing Healthcare Market Moving from Volume to Value. Supporting Better Performance. Paying for Better Performance. Paying for Higher Value. Fee for Service. Prospective Payment. Pay for Reporting. Payment for Coordination. Pay for Performance. Episode- Based Payments. - PowerPoint PPT Presentation
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Copyright © 2013 Accenture All rights reserved. Confidential information of Accenture 1
Changing Healthcare MarketMoving from Volume to Value
Key Questions:• How does this shift fit with your overall strategic agenda?• What is your position on the risk continuum?• What have you learned?• What are the major payer/operating threats moving forward?
5 Key Provider Responses to Value-Based Care Delivery1. Scale and Standardization – Growth by acquisition, standardized operating models2. Continuum Expansion – Extending service breadth and transitions across the continuum3. Provider & Clinical Integration – Tighter clinical integration and demand management 4. Patient & Family Engagement – Improved connections and navigation services5. Payer & Provider Collaboration – Improved population health management capabilities
Fee forService
Prospective Payment
Pay for Reporting
Payment for Coordination
Pay for Performance
Episode-Based
Payments
Shared Savings
with Quality
Partial or Full Capitation
with Quality Improvement
Supporting Better Performance
Paying for Better Performance
Paying for Higher Value
Copyright © 2013 Accenture All rights reserved. Confidential information of Accenture 2
Requires Enhanced Core Capabilities…
Health Analytics
Connected Health Information
Strategy, Leadership, and Governance
Care Coordination & TransitionsImprove continuum integration by coordinating care across settings and effectively managing care transitions to reduce readmissions
Provider & ClinicalIntegrationIntegrate and improve connections with providers across the continuum and align incentives with clinical outcomes
Population HealthManagementMeasure, manage, align incentives, and continuously improve the organization financial outcomes and individual and population health outcomes
Care Delivery OptimizationImprove patient access to high quality care, reduce health disparities, and improve efficiency and effectiveness of operations
Patient & FamilyEngagementImprove patient, caregiver, and family participation, empowerment, and engagement in their health care plans
Real-time, Electronic Health Information
Patient Information in other Organizations
Providers Across the Health Continuum
Patients, Families, and Caregivers
Organization Outcomes and Value
Quality Management
Care Management
Network Management
Consumer Engagement
Medical Economics
Supporting Better Performance
Paying for Better Performance
Paying for Higher Value
Copyright © 2013 Accenture. All rights reserved. Accenture Confidential Information. 3
Strategy Development includes review of key integrated care delivery processes …
Core FunctionsBetter Care for Individuals
Enabling CapabilitiesBetter Performance
Manage Market & Service Lines
Manage Health of Populations
Manage Provider Network & Integration
Deliver Continuum of Care Services
Provide Access to Information & Insights
Support the Organization
Provide Health Research & Trial
Services
Direct, Plan, and Guide the Organization
Manage Access to
Care
Manage & Process
Reimbursements
Manage Multi-Channel Consumer Interactions
Health High Performance Integrated Care Delivery Logical Operating Model
Management Capabilities
Better Health for Populations
Copyright © 2012 Accenture. All rights reserved. Accenture Confidential Information. 4
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