The initial phase of our Managed Care workgroup confirmed that the challenge of achieving fair value from MA plans is fairly universal. The next phase will be oriented around building the capabilities needed to achieve better contracts by transcending a 'selling referral quality' mindset to 'selling revenue quality.'
Building our Next Generation Revenue Engine
Many businesses currently spend an inordinate amount of resource 'triaging' referrals, meaning: Balancing the needs of referral sources and patients against the financial needs of the business. This is a resource that could - and should - be shifted into achieving better contracts, with better payer partners, and managing and satisfying those contracts. We can't just go out and hire or buy many of these capabilities. This requires marshaling a new, interdisciplinary approach that spans most of our existing business functions, as well as a couple of new ones:
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Product development
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Contract development and management
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Payer relations /communications and government affairs
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Finance – actuarial, managerial accounting, revenue cycle
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Data and analytics
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Operational and clinical support
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Compliance and regulatory support
Join us monthly as we work through elevating the dialogue about home-based care's value with MA plans and others risk-bearing entities.
