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Value-Based Reimbursement Operations: A Closed-Loop Ecosystem That Requires a Solid Back Office

Value-Based Reimbursement Operations: A Closed-Loop Ecosystem That Requires a Solid Back Office

This IDC Perspective details how hospitals and other providers are working hard to prepare for contract negotiations with payers using alternative payment models (APMs) using fee-for-value methodologies. Payers are now committed with various methodologies, interpreting Medicare goals, and are concerned with their internal pilot programs maturing. "What is underestimated is the closed-loop, multiyear, core procedural and systematic changes necessary in the middle and back offices to execute operationally under an environment where many payments will be value based," states Jeff Rivkin, research director for Payer IT Strategies at IDC Health Insights.

Please Note: Extended description available upon request.


Executive Snapshot
Situation Overview
Provider Data Management
Contract Management
Where Are My Opportunities for Savings and Better Care?
Which Episode Methodology Do I Want to Use?
Do I Have Episode Modeling Software?
Which Episodes Do I Want to Support?
How Am I Going to Price Claims in Dual (FFS/VBR) Ways?
How Strong Is My Workflow Architecture?
Are My Product/Benefit Plans Able to Be Configured Flexibly?
How Will I Adjust Claims and Rating Workflows?
What Prospective and Retrospective VBR Claims Pricing Engines Do I Buy/Build?
Once I Price Them, How Do I Reconcile FFS and VBR Claims?
What Episode Reconciliation Operational Software/Processes Do I Use?
How Am I Going to Prove Results and Pay Providers?
Future Outlook
Advice for the Technology Buyer
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Related Research
Synopsis

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