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The Uneasy Journey

Michael Zeis, for HealthLeaders Media, February 13, 2014
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This article appears in the January/February 2014 issue of HealthLeaders magazine.

Sponsored by: Conifer Health Solutions

It's not just a majority of respondents to the 2014 HealthLeaders Media Industry Survey who believe the healthcare industry will make the switch from volume to value, it's a big majority—72%. But throughout the survey results we see indications that, although large, 72% may not be big enough.

For one thing, having as many as 28% who are not convinced that they are in the final days of fee-for-service reimbursement may prompt some uncertainty even among those who accept that the transition will occur. And even though the Centers for Medicare & Medicaid Services operates on a schedule, the timing and many other aspects of the changeover remain uncertain. Healthcare providers are encouraged to expand their cadre of care partners and shift care to outpatient and ambulatory settings, but right now, today, the financial infrastructure—costs and revenue—appears uncertain, as well.

Nonetheless, we see indications that the industry is identifying and addressing the clinical, financial, and alignment issues involved with working with a larger set of care collaborators. In response to continuing pressure on revenue, costs are being squeezed out. Considering that patient volume remains the source of most revenue today, most revenue-growth methods reflect old-school tactics. But we see substantial portions of the respondent base involved in accountable care organizations, patient-centered medical homes, and other partnerships that involve shared clinical care at least and, for some, shared cost or revenue as well. Despite this uncertainty, the healthcare industry is moving toward a new financial foundation.

Quality monitoring along the care continuum

A principal mechanism for changing the economics of delivering healthcare is to shift care from the hospital environment to outpatient and ambulatory settings. For many, expanding the continuum of care brings concern about monitoring quality. More than one-quarter (27%) say that monitoring quality along the care continuum is their single greatest clinical quality improvement challenge. With more care providers involved, there are more handoffs, which may be one reason that monitoring is becoming more important.

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