If you’ve participated in any managed care discussions recently, you’ve probably sensed a growing divide between payers and providers when it comes to the topic of price.
Editor's Note: This article originally appeared on ECG's website.
Both sides are firmly entrenched in their opinion.
- Providers are experiencing significant cost increases.
- Payers are facing uncertainty stemming from COVID‑19.
Providers and payers need to shift the conversation away from price and toward shared incentives aligned around common interests and values. This is not to discount the importance of price to all parties, but rather to highlight opportunities to unlock value in your organization’s provider network.
Outlined below are five areas that present both near- and long-term opportunities for organizations to capture financial value in their provider networks.
1. Site of Service
Moving services and procedures out of the hospital and into the professional or ambulatory surgery center (ASC) setting can reduce costs for providers, patients, and payers without sacrificing quality. In 2019, the average price for common procedures performed in a hospital outpatient department was 144% higher than the average price for the same procedures in the ASC setting.[1]These lower-cost sites of service also provide a more intimate setting for patients to seek care.
As hospitals are still dealing with COVID‑19 and its repercussions on top of their normal patient load, transitioning appropriate services to outpatient settings can help lessen provider burden and increase patient access.
2. Emergency Department (ED) Avoidance
Unnecessary patient visits and high-cost resources (e.g., tests ordered, beds filled, provider utilization) make the ED an expensive setting for care. Your network and patients will see lower medical expenditures if ED visits can be avoided. There are several ways to reduce them:
- Identify patients who are at a higher risk of utilizing the ED.
- Educate patients on when it is appropriate to visit the ED
- Mitigate barriers to accessing nonemergent care.
- Collaborate with primary care physicians and other upstream care providers (e.g., behavioral health, urgent care).
Some of these steps may be time consuming and require planning, but they can alleviate pressure on the entire system and those who use it. Click here to continue>>
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