Healthcare’s migration toward a value-centric payment system is disrupting “business as usual” for most organizations and provider groups. Reform is recasting how care is provided and paid for. To survive within the evolving healthcare landscape, hospitals and healthcare systems must effectively anticipate and respond to imminent change while simultaneously positioning themselves to achieve a more suitable end state that considers the sweeping changes to which we are all responding.
ECG defines the concept of a preferred end state as a clinically integrated network in which organizations and providers band together to follow common clinical protocols, monitor aligned measures and incentives based on improved value, and jointly pursue payor contracts. Each organization is uniquely constituted, so long-term positioning strategies should be specifically tailored. With that said, all positioning strategies geared toward realizing an optimal end state must factor in the five critical components that follow, regardless of organization’s size, scope, and scale:
- Primary Care (Physician) Alignment – Primary care needs to include the characteristics of a patient-centered medical home (PCMH). Strong, suitable physician partnerships are critical to driving change and protecting short- and long-term market share.
- Care Delivery Transformation – Care delivery needs to be transformed through the design of systems of care that are built to create exceptional outcomes, with an emphasis on the utilization of evidence-based practices, patient engagement, seamless care transitions, and capacity optimization.
- Payor Contract Restructuring – Systems focused on efficiencies must renegotiate contracts to account for a shift in payor focus and improved value. As utilization is taken out of the system, organizational and provider financial performance will be at risk if contracts are not restructured.
- IT Infrastructure Development – Hospitals and healthcare systems need to focus on creating an information-driven culture of integration and accountability through the development of an appropriate electronic infrastructure.
- Network Formation – Attention needs to be given to growing a clinically integrated delivery network of providers and sites of care.
ECG works closely with each client to realize its strategic vision by defining the organization’s ideal end state; identifying the core competencies and infrastructure required; evaluating the existing capabilities, culture, resources, and challenges; and designing a clear, deliberate road map toward short and long-term, goals.
To learn more about preferred end states, read the full article.