The Kinetix Group recently released a white paper, entitled Emerging Payment Models, co-authored by John Strapp, Len Fromer, and John Walker. This is the first of an upcoming series of posts highlighting its themes. To download the paper and read more, click here.
Emerging payment models have already made an impact on the healthcare industry. Of the key trends that have emerged, The Kinetix Group has identified the following as the three most prominent: Investment in Data Management Capabilitie, Transformation of Systems of Care, and Increase in Provider Accountability.
Investment in Data Management Capabilities
The movement towards value-based payment models has enhanced the need for data management capabilities within health systems. Value-based models have catalyzed the need for care coordination among providers, which requires clinical data analytics, data sharing, and interoperability between electronic health records. These aspects of care coordination pay a key role in the improvement of care processes and quality outcomes.
Transformation of Systems of Care
The current marketplace is optimal for the formation of Systems of Care (SoCs) – groups of hospitals that focus on organizational efficiency to provide value-based care. These SoCs are reshaping provider compensation models, including capitated and other value-based arrangements, so that individual and group compensation are based on data analytics.
Figure 1: Volume to Value World, The Kinetix Group
Increase in Provider Accountability
Emerging payment models assign two types of risk – performance risk and utilization risk – to providers, which hold them accountable for the cost and quality of care they deliver. Additionally, the new payment models have encouraged providers to shift towards preventative, patient-centered care, which improves clinical outcomes by improving the doctor-patient relationship and decreasing unnecessary diagnostic testing, hospitalizations, and referrals.