As specialty medical practices model and manage potential revenue under value-based healthcare, they should prepare for both positive and negative financial scenarios, cautioned Parag Shah, president of practice solutions at Integra Connect, a provider of technologies and services for value-based specialty care.
He gave the example of alternative payment models, such as the Oncology Care Model. Under the oncology model, he says practices may receive upfront reimbursement to cover incremental costs for increased care coordination, but have to return payments later due to eligibility disconnects or if the practice fails to achieve performance metrics.
“To be successful, practice administrators will now have to model and manage anticipated revenue streams. By forecasting future cash flows and predicting both potential gains and losses, practices can identify early on whether they need to hedge against projected risk by invoking stop-loss insurance, savings accumulators or other measures,” said Mr. Shah.
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