Growing Need for Complex Hierarchy Support
As the healthcare industry’s shift to value-based care (VBC) continues to gain momentum, there is an increasing demand for complex hierarchy support for onboarding, data capture, digitization and exchange. These capabilities are key components to realizing the promise of VBC and facilitating a sustainable move to whole-health patient care.
One of the critical building blocks for administering VBC programs is the ability to support complex many-to-many hierarchies between entities in the network. These relationships become important not only for stakeholder onboarding and data capture, but also for administering payments. Real-time data sharing and value-based payment models are also vital to improving care and containing cost. However, the transition from a volume-based transactional billing model to one that incorporates financial risk tied to the patient’s health outcome is not an easy one.
While healthcare organizations generally welcome improved outcomes, their central focus has traditionally been on growing volumes in a FFS setting and maintaining margins. Despite good intentions, the real work of improving value is left undone. Legacy delivery approaches and payment structures which have remained largely unchanged for decades reinforce the problem and have produced a system with erratic quality and unsustainable costs.
For both payers and providers, legacy claims and clinical workflow technology investments also hinder the practicality of efficient administration of value-based arrangements at scale. A common barrier is the inability to onboard and manage a complex multi-stakeholder care network while accommodating the event-driven and episodic requirements of payment models that are no longer claim-centric. Another barrier is the timeliness of data reporting and the inability to understand contract performance more prospectively as opposed to after-the-fact.
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